Order Form
                                      A-Talk for Windows

Name:		____________________________________________________________

Company Name (Optional): ___________________________________________________

Address:	____________________________________________________________

City: __________________ State:_____________ Country: ___________ ZIP: _____

Phone Number: ____________________________ Fax Number: _____________________

E-Mail address: ______________________________

No. Units	Product			        Unit Price		Price
[  ]		A-Talk for Windows		$ 49.95			$ ______
[  ]		A-Talk for Windows		$ 79.95	(after 12/31/94)$ ______
		Tax (CA only)			(add, if appropriate)	$ ______
		Shipping & Handling (U.S.)	$  5.00 		$ ______
		Shipping & Handling (Overseas)	$ 10.00 		$ ______
						Total			$ ______

Payment Method:

[ ] Check 	[ ] Credit Card

[ ] Visa	[ ] Mastercard	[ ] Diner's/Carte Blanche  [ ] American Express

Credit Card Number:	______________________________________________

Expiration Date:	____________