MoreMem 4.0b Order Form - U.S. & Foreign (except Europe, Austl. & Japan)

    To: Gamma Research, Inc.                (205) 533-7103 Sales (9-5 CST)
        904 Bob Wallace Ave. Suite 212      (205) 881-5341 Tech Support
        Huntsville, AL 35801-5648           (205) 881-5341 Fax
        USA                                 gamma@traveller.com e-mail

        NOTE:  DO NOT SEND CREDIT CARD NUMBERS BY INTERNET E-MAIL.
        CREDIT CARD NUMBERS SHOULD BE SENT BY FAX, MAIL, OR PHONE.

    From:
        Name:             _____________________________________________

        Company:          _____________________________________________

        Street Address:   _____________________________________________

                          _____________________________________________

        City, State, Zip: _____________________________________________

        Country:          _____________________________________________

        Tel #:            _____________________________________________

        Fax #:            _____________________________________________

        e-mail Address:   _____________________________________________

                       Units:       1-9       10-99     100-499    500-
             U.S. Price/Unit:       $40       $35       $30        Call
    International Price/Unit:       $59       $52       $45        Call

        Quantity:         ________________
                                              $0 to Mail Password
        Shipping:         ________________    $5 per Disk ___3.5" ___5.25"
                                             $15 for Overnight Disk
        Total:            ________________   $35 for International Overnight

        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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