CYREL ORDER FORM: -Please print clearly- LAST NAME:________________________ FIRST NAME: _______________________________ COMPANY (if applicable): _____________________________________________________ ADDRESS: _____________________________________________________________________ CITY: ______________________________ STATE/PROVINCE: ________________________ ZIP/POSTAL CODE: ___________________ COUNTRY: _______________________________ PHONE NR.: ( _____ ) _____ - _______ E-MAIL: _______________________________ FAX NR. : ( _____ ) _____ - _______ E-MAIL SYSTEM: ________________________ COMMENTS & SUGGESTIONS: ______________________________________________________ ______________________________________________________________________________ ______________________________________________________________________________ ORDER FORM: Please read all the ordering information before signing this form. Allow 3 to 4 weeks for delivery. ------------------------------------------------------------------------------ QTY. | CODE | DESCRIPTION | UNIT PRICE | TOTAL ------|--------|-------------------------------------|------------|----------- | | | | ------|--------|-------------------------------------|------------|----------- | | | | ------|--------|-------------------------------------|------------|----------- | | | | ------|--------|-------------------------------------|------------|----------- | | | | ------|--------|-------------------------------------|------------|----------- | | | | ------|--------|-------------------------------------|------------|----------- | | | | ------|--------|-------------------------------------|------------|----------- | | | | ------|--------|-------------------------------------|------------|----------- | | | | ------|--------|-------------------------------------|------------|----------- | | | | ------|--------|-------------------------------------|------------|----------- | | | | ------|--------|-------------------------------------|------------|----------- | | | | ------|--------|-------------------------------------|------------|----------- | | | | ------|--------|-------------------------------------|------------|----------- | | | | ------------------------------------------------------------------|----------- Subtotal of all items ordered | |----------- Deduct U.S. $5.00 if you previously ordered the CyReL Catalog Disk| |----------- Shipping and handling charges | (See schedule in product list)|----------- __________ TOTAL | | ---------- DATE: ____ - ____ - 19____ NAME: ___________________________________________ SIGNATURE: ___________________________________________ Method of payment: All orders must be prepaid. Cheque/Money Order in U.S. funds only. Minimum Order is U.S. $10 (Continental U.S.), U.S. $25 (Other). PLEASE ANSWER THE FOLLOWING QUESTIONS: COMPUTER: CPU: WHERE DID YOU LEARN ABOUT THIS PRODUCT: [] ST [] 68000 [] Magazine article/review _________________________ [] Mega ST [] 68010 [] Magazine advertisment _________________________ [] MEGA STE [] 68020 [] Dealer visit ____________________________________ [] TT030 [] 68030 [] Trade show ____________________________________ [] Falcon 030 [] 68040 [] Network _________________________________________ [] Portable [] 68060 [] BBS _________________________________________ [] Personal recommendation _________________________ WHERE WILL YOU USE THIS PRODUCT: [] Primarily at home [] Primarily at work [] Both equally MAIN APPLICATION(S): _____________________________________________________________________________ STof194/IX Mail to: Cybercube Research Limited 126 Grenadier Crescent Thornhill, Ontario L4J 7V7 Canada ...................................................................o/........ Cut along the dotted line. For terms and conditions, please refer to TERMS.TXT. For a detailed description of the warranty, please refer to WARRANTY.TXT