PERILINK
                               5101 Halifax St.
                            Little Rock, AR 72209
                                     USA


                            Please: Print or Type

                            Date:  ____/____/____
                                   (MM   DD   YY)


     Name _________________________________________________________________

     Company Name _________________________________________________________

     Address ______________________________________________________________

     City ____________________________ State __________ Zip _______________


                Please specify:        [ ] 5.25          [ ] 3.5


          Disk Title(s) (1) _____________________________________
                        (2) _____________________________________
                        (3) _____________________________________


          Number of copies (1) _____    x price=    $ _____________
                           (2) _____    x price=      _____________
                           (3) _____    x price=      _____________

          For overseas shipping and handling      + $ _________5.00

          Total amount of this sale                 $ _____________
          
          
          Important: Please indicate how you heard of us:

          _______________________________________________________


               Send check or money order for the total amount
               in U.S. funds only please.

               For Canadian and overseas orders: Please remit
               a check or money order drawn on or payable
               through a U.S. bank.

                            Thank you very much!

                 Please allow four to six weeks for delivery