LanguageQuest - Fax Order Form

LanguageQuest Traveler

FAX ORDER FORM » SHIPPING INFO & RATES (CLICK)

Print and complete this form. Then FAX it to: 650- 941- 6119

BILLING ADDRESS:

Name___________________________________________________________________

Address_________________________________________________________________

City _______________________State _______ Zip _________ Country _______

Daytime Phone ____________________ FAX number _____________________________

E-Mail Address _____________________________

Payment [ ]MasterCard [ ]Visa [ ]American Express

[ ]Check - Mail to: LanguageQuest, 220 State St, Los Altos, CA 94022 USA

Credit Card Number __________________________________________________________

Expiration Date ______________________________________________________________

Name as it appears on Card __________________________________________________

Signature of Card Owner _____________________________________________________

ITEMS ORDERED:

Item #1 ______________________________________ [ ]Mac [ ]Win 3.1 [ ]Win 95/98 Price $_________

Item #2 ______________________________________ [ ]Mac [ ]Win 3.1 [ ]Win 95/98 Price $_________

Item #3 ______________________________________ [ ]Mac [ ]Win 3.1 [ ]Win 95/98 Price $_________

Item #4 ______________________________________ [ ]Mac [ ]Win 3.1 [ ]Win 95/98 Price $_________

Item #5 ______________________________________ [ ]Mac [ ]Win 3.1 [ ]Win 95/98 Price $_________

Item #6 ______________________________________ [ ]Mac [ ]Win 3.1 [ ]Win 95/98 Price $_________

Subtotal: $_________

California Sales Tax (California deliveries only) @ 0.0825 (8.25%) $_________

Shipping & Handling (See »Shipping Info): $_________

TOTAL Charged to your credit card $_________

LanguageQuest Traveler

TOLL FREE: 1-800-622-3574 INT: 650-941-6383 FAX:650-941-6119

220 State St, Los Altos, CA 94022 USA