ELECTRONIC TECHNOLOGIES ORDER FORM 3/22/91 - SUBJECT TO CHANGE WITHOUT NOTICE.

____ PLEASE SEND ME MORE INFORMATION ABOUT POSTAL BARCODES

____ PLEASE SEND ME MORE INFORMATION ABOUT STANDARD BARCODES


There is a 15% discount for qualified resellers.
Quantity discounts start at purchases of 15 or more copies.

PRICE QUAN TOTAL

RemoteControl (fax/modem/answerer 1 line) $35.00 ea. ____ $______

BeepMe (phone message alert/pager alarm) $30.00 ea. ____ $______

IRS:Log/Report (records each PC program) $25.00 ea. ____ $______

LAPTOP GasGauge (watches battery life) $20.00 ea. ____ $______

SHAREWARE (all our shareware on 1 disk) $5.00 ea. ____ $______

-----------------------------------|
VISA/MC orders 1-800-325-7379 | Michigan residents add 4% $______
Information: 1-313-656-0630 |
| Add $4 shipping/handling $ 4.00
Or mail to: |
Charles Eglinton | Add $2 for each 3.5" diskette $______
c/o Electronic Technologies |
3985 S. Rochester Road, Ste. H | TOTAL: $______
Rochester, MI 48307 |
------------------------------------------------------------------------------

NAME:____________________________________________________

ADDRESS:____________________________________________________

CITY:____________________________________________________

STATE:________________________ ZIP CODE:_________________

PHONE:________________________


PLEASE ANSWER THESE QUESTIONS SO THAT WE MAY SERVE YOU BETTER:

WHAT IS THE NAME & PHONE OF THE
BBS WHERE YOU FOUND THIS PROGRAM?__________________________________

WHAT KIND OF COMPUTER DO YOU USE?__________________________________

WHAT KIND OF MODEM DO YOU USE?_____________________________________

WHAT IS YOUR OCCUPATION?___________________________________________

HOW DO YOU INTEND TO USE THIS PROGRAM?_____________________________

DO YOU FEEL THE REGISTRATION IS TOO HIGH, OKAY or TOO LOW?_________