
                VRAMDIR for Windows 95 Order Form
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Given Name:                   Family Name:
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Company:
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Street:
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City:                     State:            Zip Code:
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Country:
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Email:
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               Unit Price          Quantity       Sub Total
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Email Copy          US$10     X            =
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US Floppy Copy      US$15     X            =
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Int'l Floppy Copy   US$20     X            =
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                   WA residents add 8.2% Tax
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                                       Total
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Credit Card Number:
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Expiration Date:         Cardholder Name:
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Card Billing Address:
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City:                     State:            Zip Code:
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Cardholder Signature:                           Date:
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Please fill out this form and fax it to (206)649-8277.

You can also mail it to:

Virtual Software Corporation
15016 SE 63 Street
Bellevue, WA 98006
USA

