Category : Pascal Source Code
Archive   : TVGAS20.ZIP
Filename : ORDER.DOC

BSX International Order Form

I wish to register or purchase the following BSX products:

Register or Disk
Purchase ? size
Circle for
one: Purchases:

___ copies of ______________, @ $______ each: $______ Reg / Pur 5.25 / 3.5

___ copies of ______________, @ $______ each: $______ Reg / Pur 5.25 / 3.5

___ copies of ______________, @ $______ each: $______ Reg / Pur 5.25 / 3.5

___ copies of ______________, @ $______ each: $______ Reg / Pur 5.25 / 3.5

___ copies of ______________, @ $______ each: $______ Reg / Pur 5.25 / 3.5

___ copies of ______________, @ $______ each: $______ Reg / Pur 5.25 / 3.5

___ copies of ______________, @ $______ each: $______ Reg / Pur 5.25 / 3.5

For a total of: $______

I've enclosed a check or money order payable to Robert Roberds.

Please ship purchased products to:
(Please print)
Name:_____________________________________________________

Street Address:___________________________________________

City, State/Province:_____________________________________

Zip Code:_____________ Country:_______________________

Phone (Optional):_________________________


I understand that registered products are not to be delivered, while
purchased products are.

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Send this form along with check or money order to:

BSX International
806 Park Ridge Rd. Apt. A8
Durham, NC 27713

Please allow 1-2 weeks for delivery of purchases. Thanks!