ORDER FORM Name: ______________________________________________________________ Company: ___________________________________________________________ Address: ___________________________________________________________ City: _____________________ State: ________ ZIP: _________________ Country (if outside US): ___________________________________________ Phone Number (optional): _____________ Circle: home or work E-mail Address (optional except E-mail Shipping): __________________ Where you found Shareware Version (optional): ______________________ Product Quantity Price Each Total =================================================================== PixWizard for Windows 95/NT ____ $30.00 U.S. _____ PixWizard Upgrade Fee (from any registered version of WinJPEG) ____ $10.00 _____ PMJPEG for OS/2 2.x and Warp ____ $20.00 U.S. _____ WinJPEG for Windows 3.x ____ $25.00 U.S. _____ WinJPEG Update Fee (from any registered version of WinJPEG) ____ $5.00 U.S. _____ Murals for Windows 3.x ____ $15.00 U.S. _____ =================================================================== Merchandise Total: ______ 5% Sales Tax (Massachusetts residents only): ______ Shipping and Handling (choose one): ______ __ E-mail (no additional charge) __ U.S. residents (add $5 U.S.) __ Non-U.S. residents (add $8 U.S.) TOTAL: ______ Non-credit card order payments must be in U.S. cash, U.S. funds drawn on a U.S. bank, or a postal money order. Please make checks payable to: PixVision Software Please fill in the following for Credit Card Orders: Signature: _______________________ Name on Card: ____________________ Visa [ ] MasterCard [ ] Credit Card Number: ________________________ Exp. Date: _______ Mail to: Internet Address: PixVision Software orders@pixvision.com 58 Chandler St. Boston, MA 02116 U.S.A. Visit our Web page! http://www.pixvision.com