EZRECV Order/Registration Form

 Please include this form with any order or registration of
                           EZRECV.

        Send this form with check or money order to:

                     Express Consulting
                4960 Hamilton Ave.  Suite 211
                     San Jose, CA  95130
              (408)374-7992  (408)374-3115(FAX)
                              
                              

Enclosed is my payment for the following items:

Product                             Qty      Price      Total

EZRECV Communications Software      ____     $29.00    _______
Check Disk Size: 3 1/2" ____
                 5 1/4" ____

Shipping & Handling				         N/C

Sales Tax(8.25% in California)                         _______


                                        Total Cost     _______


This offer is valid until 12/92.



Ship to:


     Name:   ___________________________________________________


     Company:___________________________________________________


     Address:___________________________________________________


     Address:___________________________________________________


     City:   _____________________   State:____  Zip:___________


     Phone:  (____)____ - ________  FAX: (____)____ - __________