O R D E R   F O R M


	   TO:  V-QLIB                                   Date____/____/____
		c/o Eric L. Yale
		Rt 1 Box 327-N
		LaGrange, NC 28551


         From:  Name _______________________________________________________

                Address ____________________________________________________

                City __________________________ State ________ Zip _________

                Area Code (______)  Phone __________________________________



		     PRODUCT-------QUANTITY--  EACH-------   EXTENDED-

		     "V-QLIB"       ______  X   $25.00each    $________

						Sub-Total     $________

                                                Total          $_______




                --------------------- User comments ----------------------

		I acquired V-QLIB v1.4 from
                   [ ] - Friend                    [ ] - Software product
                   [ ] - Computer Club             [ ] - Computer Store
		   [ ] - Data Base Service         [ ] - PC-SIG

                Comments or suggestions: ___________________________________
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                problems:___________________________________________________
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