


"DbDOC"

ORDER FORM




Name:    _________________________________________________________

Company: _________________________________________________________

Address: _________________________________________________________

City:    ______________________   State: _____  Country: _________

Zip:     ______________________   Phone: _________________________



          Quantity ...........  _______  @ $75.00 each = $________

          Shipping & Handling .......................... $    5.00

          Florida Residents Add Sales Tax ...............$________

          Total ........................................ $________


          Payment Method:          Check or Money Order


          Please Specify Diskette Size: 3.5"      5.25"


SEND TO:

          THE NESHEM CORPORATION
          1301 W. Garden Street
          Pensacola, Fl. 32501
          Phone: (904) 438-7011
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