


                           ORDER Form  Fax or Mail


   From: ________________________________________  ___________________
           Name                                       Title

         _____________________________________________________________
           Company

         _____________________________________________________________
           Address

         _____________________________________   _____   _____________
           City                                  State   Zip

         Phone (    )       -              (    )       -          fax
                ----   ----   --------      ----   ----   --------


   To:
   Order Dept.
   Infinity Imaging Products
   2000 Corporate Ridge #900
   McLean, VA 22102
   (703) 866-4189     __________________ fax



    Products Ordered

    Qty    Product                            Price       Amount

    ___    ________________________________   $_____     $_______

    ___    ________________________________   $_____     $_______

    ___    __________________________ $____   $_______   $_______

    ___    __________________________ $____   $_______   $_______

    ___    __________________________ $____   $_______   $_______

                                           Subtotal      $_______

                                  5% Tax if VA Address   $_______

                                           Shipping         $3.00

                                           Total PAID    $_______


     Paid by  [ ] Check  [ ] Credit Card: [ ] MC  [ ] Visa  [ ] Discover
              [ ] Other "

     Credit Card # ______________________________ Exp Date:______________

     Signature:________________________________

