## Order a Pixel Monkey Product

Introductory Special
For a limited time, you can order the Pixel Monkey CD-ROM for only $19.95 plus shipping and handling. That's $10.00 Off the list price! To order call Bitwise Internet at (800) 875-1666 during business hours (8:30am - 6:00pm Eastern Standard Time, Monday through Friday), fill in the form below and fax it to us at (617) 261-7788 or order from our Web Site! |

### 1. Product:

__Pixel Monkey CD-ROM

Quantity:

### 2. Shipping Information

Name:
Company:
Address:
Address2:
State:
Zip:
Day Phone:
Eve. Phone:
Fax:
E-Mail Address:

### 3. Payment Information

Payment to be made with:
__Visa
__MasterCard
__Discover
__American Express
Credit Card Number:
Expiration Date :
Name as it Appears on the Card:

### 4. Delivery Options

Select shipping method:
__Ground ($5.00)
__Two Day ($10.00)
__Overnight ($15.00)

### 5. Billing Address

(If the address where you receive your credit card bill is different from the shipping address above you must also provide your credit card billing address here.)
Name:
Company:
Address:
Address2:
City:
State:
Zip:

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