INNOVATIVE BUSINESS TECHNOLOGIES, INC. ++++++++++++++++++++++ 7137 SHADY NELMS DRIVE, SUITE #204 | RexxVIM Order Form | COLUMBUS, OH 43017 ++++++++++++++++++++++ VOICE/FAX: (614) 791-9055 Date: _______________ Company Name: _________________________________________________ Name: _________________________________________________ Address: _________________________________________________ City: ________________________ State: ____________ Zip Code: ________________________ Country: ____________ Telephone: ________________________ Fax: ________________________ ================================================================ Version of ccMail or Lotus Notes currently in use: ____________ For electronic distribution, please list your e-mail address - CompuServe Internet Prodigy America Online Address: _________________________________________________ ================================================================ Quantity Product Description Cost Total ________ RexxVIM for OS/2 $295.00 __________ Shipping and Handling 4.00 Ohio Residents add 5.75% Sales Tax __________ TOTAL ORDER ========== Please send your completed order form, including a check or money order (U.S. Funds only) payable to: Innovative Business Technologies, Inc. ================================================================ For faster service, fax us your order by including your credit card information: CREDIT CARD: VISA MASTERCARD CREDIT CARD NUMBER: ____________________________________________ EXPIRATION DATE: ____________/_______________/_______________ SIGNATURE: ____________________________________________ ================================================================