ORDER FORM NAME: _____________________________________________ DATE:____________ STREET ADDRESS:_______________________________________________________ CITY:_____________________________ STATE:_____ ZIP:___________________ ( ) Check ( ) AmX ( ) MasterCard ( ) VISA Sig.__________________ CARD NUMBER:___________________________________ EXP DATE: ____________ ===================================================================== Item # Description Price # Ord. Total ====== ================================= ===== ====== ======= ______ _________________________________ $_____ ______ $______ ______ _________________________________ $_____ ______ $______ ______ _________________________________ $_____ ______ $______ ______ _________________________________ $_____ ______ $______ ______ _________________________________ $_____ ______ $______ ______ _________________________________ $_____ ______ $______ ______ _________________________________ $_____ ______ $______ ______ _________________________________ $_____ ______ $______ ______ _________________________________ $_____ ______ $______ ______ _________________________________ $_____ ______ $______ ______ _________________________________ $_____ ______ $______ ______ _________________________________ $_____ ______ $______ ______ _________________________________ $_____ ______ $______ ______ _________________________________ $_____ ______ $______ ______ _________________________________ $_____ ______ $______ ______ _________________________________ $_____ ______ $______ ______ _________________________________ $_____ ______ $______ Shipping & Handling $ 2.50 Sales Tax (Texas orders only - 8.25%) $______ Mail to: DataWare Productions Cy Stapleton 3200 S. John Redditt Dr., Lufkin, TX 75901 (409) 637-7468, FAX (409) 637-1480