My Little Realm Order Form

          Last: ___________________________  First: ________________  M.I. ___

          Address: ___________________________________________________________

          City: _________________________________________  State: ____________

          Zip: ________________ Home Phone: (________) _______________________

          Note:  All program disks will be sent to this address.
          ____________________________________________________________________

          Indicate which programs you are purchasing:

                ____  Calling Cards              ____  Public Library
                ____  Charge Card                ____  Read More
                ____  Checking                   ____  Records of the Realm
                ____  Private Library            ____  Savings

          Number of programs purchased _____ at $20 each          _________
          ____________________________________________________________________

          Bonus program:  ____________________________________________________
          Limit:  One bonus program with your order.
          ____________________________________________________________________

          ____  I'd rather save $100!  Rush me MLR/the System for only $60.

          My Little Realm/The System   _______   at  $60/system   _________
          ____________________________________________________________________

                                              Shipping/Handling   __$5.00__

                                                       Subtotal   _________

                   New Jersey residents please add 6% sales tax   _________

                                       Total amount of purchase   _________
          ____________________________________________________________________
          
          Disk size:   _____   5 1/4"   _____   3 1/2"    (Disks are DS/DD)

          Vendor/BBS name:  __________________________________________________
          ____________________________________________________________________

          Please send your check or money order to:  

                              John L. Salisbury 
                              22 Church Street #103, Suite 376
                              Ramsey, New Jersey 07446

          Checks and money orders must be drawn on U.S. banks in U.S. funds.
          Sorry, phone orders cannot be accepted.  Prices subject to change.
          ____________________________________________________________________