		Variable Conversions Order Form
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	To order your own full feature copy of Variable 
	Conversions for the low cost of $25.00 U.S. , 
	$30.00 (Can), please fill in the following 
	information for our records.  

	Please note that Variable Conversions requires
	Microsoft Windows version 3.1 or higher.
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	Personal Information:

	Full Name:________________________________________

	Street Address:___________________________________

	City & State/Province:____________________________

	Zip/Postal Code:__________________________________

	Phone Number:(   )_______Fax Number:(   )_________
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	Statistical Information (Optional):

	Where did you hear about Variable Conversions?
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	Age:_______ Sex:__________ Occupation:____________
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	Purchasing:

	Number of copies:______   
	X $25.00 (U.S.) $30.00 (Can) 		$_________

	For Canadian Residents Only (7% P.S.T.)	$_________

	For B.C. Residents Only     (7% G.S.T.)	$_________

					Total:	$_________
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	Payment:

	Please pay by cheque or money order and stipulate 
	U.S. or Canadian funds.  Payment may also be made 
	using a Visa or MasterCard.  Please give the card 
	number and expiry date below.

	Visa/MasterCard (Circle one) 	Card#:____________
	 				Expires:__________
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	Mail/Fax to:

	Garibaldi Enterprises	
	Suite 330-878 1733 H St. 
	Blaine, Washington	
	98230-5107		
	Fax: (206)322-7679

		or

	Garibaldi Enterprises
	121 - 1489 Marine Drive Ref. 21
	West Vancouver, B.C. Canada
	V7T 1B8
	Fax: (604)926-4854
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