Ŀ
 Send Orders to:               INVOICE/REG. NO.                             
 E Z X  Publishing                                    YOUR P.O. OR OTHER NO 
 P.O. Box 58177-FF11          Ĵ
 WEBSTER, TX 77598  USA       DATE:                  REF/EXT:               
 FAX:713/280-0525             Ĵ
Eff.7/92     U P S SHIPPER # T X  X X X- X X X 
Ŀ  Red Label? [  ]    ZONE [      ] 
 SOLD TO: (ATTN: ACCOUNTS PAYABLE)          Blue Label?[  ]                  
Ĵ  Ground?    [  ]   WEIGHT[      ] 
                                            Mail?      [  ]                  
                                            Insured?   [  ] $                
                                            Certified? [  ]  See rates below.
                                            Other?     [  ]  S&H is $7 min.  
                                           Ĵ
                                           SPECIAL INSTRUCTIONS:            
                                  
Ŀ You may order with your VISA,    
  S H I P  T O : (IF DIFFERENT THAN ABOVE) MasterCard, American Express, or 
Ĵ Discover charge card by calling: 
                                            1-713-280-9900  extension FF11  
                                           This number will accept orders   
                                           only. For any other information  
                                           including purchase orders and    
                                           site licensing, etc. call:       
                                             1-713-280-9900 extension FF11  
                                                                            
Ĵ
TERMS: PAYMENT DUE ON DELIVERY. OTHER?                      SOLD BY:          
Ĵ
TAX EXEMPT?        REASON:          TAX #                   EXT:              
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CONTACT:                           DATE:             TEL# (     )             
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V/MC/AX/O #                              EXP. DATE:   /    AUTH CODE.         
(CIRCLE)  NAME OF CARDHOLDER.                                                 
TEL NOS REQD: DAY/OFC.(     )            EVE.(     )                 PROC?Ĵ
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SOURCE OF ORDER?                    Old/New Reg#                             
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   ITEM  (All prod. incl. printed manual)  Quantity Price      EXTENSION   
Ĵ
 MENU-EZX Ultimate Hard Disk Menu System           $ 39.00                 
Ĵ
 EZ-FORMS FIRST (Manual, 50+ forms, manual..)      $ 39.00                 
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 EZ-FORMS DATABASE                                 $149.00                 
Ĵ
 EZ-FORMS PLUS      ($69 manual & 90+forms)        $ 69.00                 
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 EZ-FORMS EXECUTIVE ($129 manual & 90+forms)       $129.00                 
Ĵ
 EZFX FORMS DISK COMBO PACK ($119srp)$99w/ord      $119.00                 
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S&H:$7 min.$12-2day/US48CANADA/APO/FPO/HI/AK/PR,$12Fgn.$24                
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All pricing STC w/o notice. POs accepted from govtSUB-TOTAL                 
& rated companies. ($50 minimum) Ĵ
USA Checks only. 10 bus.day clearSalesTax 8.25% TX must add.                
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Amt.Rcvd.     Ck#      Due       Min. $6 shipping & handling                
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1-orig/2-label/3-customer/4-packing    THANK YOU!     TOTAL                 

