---------------------------------------------------------------------

                                Order Form - CDB

     
    Name:              _________________________________________________

    Company:           _________________________________________________

    Address:           _________________________________________________

    City, State, Zip:  _________________________________________________

    Telephone:         _________________________________________________

    Country:           _________________________________________________

    E-Mail Address:    _________________________________________________


    Disk Media:

    5 1/4 " diskette     ____

    3 1/2 " diskette     ____

    Number of Copies     ____  X  $99   = ______________


    Payment Type:

    Check / Money Order  ____

    American Express     ____   Card No:       __________________________

                                Expiration:    __________________________

                                Name on Card:  __________________________

                                Signature:     __________________________


    * New Jersey residents please add %7 sales tax.
    * All checks or money orders must be payable in US Dollars.

    COMMENTS: Please feel free to add your thoughts or suggestions!

    _____________________________________________________________________

    _____________________________________________________________________

    _____________________________________________________________________


    Mail to:                    Daytris
                                81 Bright Street, Suite 1E
                                Jersey City, NJ  07302
                                201-200-0018