
MEDIA BASE 1.0 ORDER FORM

NAME:		_____________________________________________________________

ADDRESS:	_____________________________________________________________

CITY:		_____________________________________________________________

STATE:		_____________________________________________________________

ZIP CODE:	_____________________________________________________________

COUNTRY:	_____________________________________________________________

PHONE:		_____________________________________________________________

FAX:		_____________________________________________________________

MEDIA TYPE:	Floppy Disk [   ]	CD-ROM [   ]


US orders only:	$19.95 + $3.95 shipping and handling, add $1 for each additional.
Outside US:	$19.95 + $7.95 shipping and handling, add $2 for each additional.

Send check or money order to:
	COLLECTIVE BASE SOFTWARE
	P.O. BOX 280
	ETTERS, PA 17319

for Credit Card orders check out CD WORLD on the INTERNET @:
	http://www.cdworld.com
