



                                    INVOICE

                            


                                               
                                               DATE ______________

        
        Ordered by:                                            
     

        COMPANY OR SHOP NAME _____________________________________
     
                     ADDRESS _____________________________________

            CITY, STATE, ZIP _____________________________________
          
                      TEL NO _____________________________________
     
                CONTACT NAME _____________________________________                       
     
         
     
         Qty      Description                 Price each      Total due  
        ----    -----------------------      -----------    -----------

        ____    CONSIGNMENT SHOP HELPER      $ 45.00        ___________
     
        
        5 1/4" ______   3 1/2" ______ disk.
     
     

        CASH   ____                   MASTERCARD # _________________________
        
        CHECK # __________                  VISA # _________________________
                                            
                                 EXPIRATION DATE   _________________________
        
        
        Remit to:                
                                           
        Jack's Software                                   
        2330 West Third Street              
        Bloomington IN 47404
                                            
        Tel No. 812-331-0770
                                 
        

                                                   
     
                                                   










                                     


