Order Form

   Mail Orders To: (See README.TXT for further ordering information)
 
     BMT Micro              or   BMT Micro
     PO Box 15016                452 Horn Road
     Wilmington, NC 28408        Wilmington, NC  28412-2411
     U.S.A.                      U.S.A.
 
   Mail sent to the post office box arrives first and is processed first.
   You can often cut a day off your order arrival time by using the PO box.
 
   We accept Visa, Mastercard, Discover, American Express, EuroCard,
   Optima, Money Order, Cashiers Check, Personal Check.  Please do not
   send cash in the mail.  Personal checks are subject to clearance.
 
   Name ________________________________________________________________
   Company _____________________________________________________________
   Address _____________________________________________________________
   Address _____________________________________________________________
   Phone ___________________________ Fax _______________________________
   Email Address _______________________________________________________
 
   Product                    Quantity        Price
   _________________________  ___________     ____________
   InfoLog                    ___________   x $19.95 (US)  = + $ _______
   InfoMiles and InfoLog      ___________   x $34.95 (US)  = + $ _______
   Shipping and Handling (Free - 1st Class)                  + $ _______
     $ 7.00 - Airborne (USA Only, $12.00 Alaska and Hawaii)
     $13.00 - Federal Express (USA Only, $18.00 Alaska and Hawaii)
     $25.00 - Federal Express (Canada/Mexico)
     $30.00 - Federal Express (Europe/Japan)
     $20.00 - Express mail (Outside USA)
   Total                                                       $ _______
 
    For credit card payment only:
    Circle one  VISA / Mastercard / Discover / American Express / Optima
    Credit card number  ________________________________________________
    Expiration date  ___________________________________________________
    Authorization signature   __________________________________________