POWERTIME 1.00 ORDER FORM ------------------------- NuIQ Software, Inc. Post Office Box 832 Larchmont, New York 10538 USA Tel: (914) 833-3479 Fax: (914) 833-3623 Quantity Description Each Total -------- ----------- ---- ----- _______ PowerTime Chart Program $15 _____ Shipping And Handling: $5 first item, $2 each add'l in USA 48 States $12 first item, $2 each add'l in AK, HI, PR, VI, GU, AS, FPO, APO and Canada $24 first item, $4 each add'l overseas _____ SALES TAX: NY residents add sales tax for your county _____ TOTAL _____ If ordering by check, please make checks payable to: NUIQ SOFTWARE INC. If you would like to order by credit card, orders may be placed by telephone at 914-833-3479 or by fax at 914-833-3623. For mail orders by credit card, please complete the following information: Cardholder: ______________________________________________________ Card Type: VISA / MASTERCARD / DINERS CLUB / CARTE BLANCHE Card Number: ______________________________________________________ Expiration: ______________________________________________________ Signature: ______________________________________________________ Date: ___/___/_____ Name: ______________________________________________________ Company: ______________________________________________________ Address: ______________________________________________________ ______________________________________________________ Phone: ______________ Fax: ____________ BBS: _______________ Disk Type: 5.25" _____________ or 3.5" _____________ How did you hear about PowerTime: ___________________________________________________________________ ___________________________________________________________________ Comments: ___________________________________________________________________ ___________________________________________________________________