Data Wave             -----=====[ ORDER FORM ]=====-----              Data Wave
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SOLD TO:
           Name____________________________________________________

        Address____________________________________________________

               ____________________________________________________   

           City__________________________  State______  ZIP _______

          Phone__________________________  FAX_____________________

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QTY |                         DESC                         | PRICE   | TOTAL
----+------------------------------------------------------+---------+---------
    | ROTAKTIX strategy puzzle arcade game 256 color VGA   | $19.00  |
    | with sound blaster music and sound effects           |         |
----+------------------------------------------------------+---------+---------
    | FLOATRIS floating blocks arcade game 256 color VGA   | $15.00  |
    | with sound blaster music and sound effects           |         |
----+------------------------------------------------------+---------+---------
    | ARCADE puzzle pak.  The full deluxe versions of both |         |
    | Rotaktix and Floatris.  Save $5.00!!                 | $29.00  |
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shipping for destinations in the United States is FREE!              | FREE
---------------------------------------------------------------------+---------
International    $1.00 for 1 game packs, $2.00 for multi-game        |
    shipping:    packs. $8.00 for Fedex/UPS/DHL/etc. (specify)       |
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Subtract Data Wave discount coupon     | (coupons are found in the)  |
(only 1 may be redeemed at a time)     | (registered versions)       |
---------------------------------------+---+-------------------------+---------
[ ] High density [ ] Low density           |                         |
[ ] 3.5" Disk    [ ] 5.25" Disk            |            GRAND TOTAL  |
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Payment can be made via personal check or money order.  International orders 
must have funds drawn on a US bank or an IRC.
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MAIL COMPLETED FORM & PAYMENT TO:

Data Wave
Suite 457
13500 SW Pacific Hwy
Portland, OR   97223


Please allow 2 weeks for domestic orders, 3 weeks for international orders.

We thank you for your order and sincerely hope that you enjoy your Data Wave
entertainment products as much as we have enjoyed bringing them to you!