MoreMem 4.0 Order Form

    To:  Gamma Research, Inc.
         112 Teakwood Drive
         Huntsville, AL 35801
            
         (205) 533-7103  Sales (9am-5pm CST) Voice and (24-hour) FAX
         (205) 881-5341  Tech Support
    
    From:               
         Name:             ____________________________________________
     
         Company:          ____________________________________________
     
         Street Address:   ____________________________________________
     
                           ____________________________________________
     
         City, State, Zip: ____________________________________________
     
         Phone #:          ____________________________________________
     
         FAX Phone #:      ____________________________________________
     
         e-mail Address:   ____________________________________________
     
    Units:               1-9       10-99      100-499    500-       1000-
    Price/Unit:          $40       $35        $30        $20        Call    
  
         Quantity:         ________________
                                               $0 for Password
         Shipping:         ________________    $5 per Disk ___3.5" ___5.25"
                                              $15 for Overnight Disk
         Total:            ________________
     
         Payment Method    ___Visa ___MC ___Amex ___Check ___Cash ___MO ___PO
     
         Credit Card #     _______   _______   _______   _______
                     
         Expiration Date   _____ / _____
     
         Signature         ____________________________________________
     
    How did you hear about MoreMem ?   ________________________________
 
    Where did you get MoreMem ?        ________________________________

    Suggestions:           ____________________________________________

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