VRAMDIR for Windows 95 Order Form ================================= ================================================================= Given Name: Family Name: ----------------------------------------------------------------- Company: ----------------------------------------------------------------- Street: ----------------------------------------------------------------- City: State: Zip Code: ----------------------------------------------------------------- Country: ----------------------------------------------------------------- Email: ================================================================= ================================================================= Unit Price Quantity Sub Total ----------------------------------------------------------------- Email Copy US$10 X = ----------------------------------------------------------------- US Floppy Copy US$15 X = ----------------------------------------------------------------- Int'l Floppy Copy US$20 X = ----------------------------------------------------------------- WA residents add 8.2% Tax ----------------------------------------------------------------- Total ================================================================= ================================================================= Credit Card Number: ----------------------------------------------------------------- Expiration Date: Cardholder Name: ----------------------------------------------------------------- Card Billing Address: ----------------------------------------------------------------- City: State: Zip Code: ----------------------------------------------------------------- Cardholder Signature: Date: ================================================================= Please fill out this form and fax it to (206)649-8277. You can also mail it to: Virtual Software Corporation 15016 SE 63 Street Bellevue, WA 98006 USA