                    AUTOMEDIA BACKDROP ORDER FORM

                              Price    Quantity    Extended Price
BACKDROP
Introductory Price           $39.95    ________    ___________________
                   ($59.95 after Jan 31, 1996)
Sales Tax:                                         ___________________

($4.95 each)          Shipping/Handling:           ___________________

TOTAL:                                             ___________________

To order by phone, call (800) 428-2777.

Name:                    _____________________________________________

Address:                 _____________________________________________

                         _____________________________________________

City, State, Zip/Postal: _____________________________________________

Daytime Phone:           _____________________________________________
(In case there is a
 problem with your order)

E-mail or FAX:           _____________________________________________
(optional)

Payment Method:          [ ]Visa   [ ]Mastercard  [ ]Check/Money Order


Name:                    _____________________________________________
(exactly as it appears on credit card)

Account Number:          _____________________________________________


Expiration Date:         _____________________________________________



Signature:               _____________________________________________
(Required for all credit card purchases)

Mail or FAX this order form to:
                                    Automedia, Inc.
                                    P.O. Box 629000
                                    El Dorado Hills, CA 95762
                                    FAX: (800) 582-8000
                                    
