ORDER FORM *** ITGraph(tm) by INDRA Technology, Inc.

THANK YOU FOR PURCHASING THE ITGraph(tm) VBX.  
PLEASE PROVIDE ALL INFORMATION REQUESTED BELOW.

ITGraph 1.2 VBX .......................$79.95
[ ] Sales Tax (CA Residents Only) ..... $5.60
Shipping & Handling:
        [ ] US 1st Class ........$5.00
        [ ] US 2nd Day Air .....$10.00
        [ ] US Next Day Air ....$15.00
        [ ] International Air ..$10.00 _______

TOTAL ................................ _______

ENTER SHIPPING ADDRESS BELOW:
        NAME:___________________________________________________
        COMPANY:________________________________________________
        ADDRESS:________________________________________________
                ________________________________________________
        CITY:________________________  STATE:____ ZIP:__________

        PHONE:(_____)______________ EXT__________
        FAX:(_____)________________ EMAIL:______________________

PAYMENT METHOD (Please Indicate Choice):
        [ ]CREDIT CARD (Check One):
            [ ]VISA     [ ]MASTERCARD    [ ]AMERICAN EXPRESS
            CARDHOLDER*:_____________________________________
            CARD NUMBER:_____________________________________
            EXPIRATION DATE:_______________
            *Please copy exactly as appears on credit card.
        [ ]CHECK**
        [ ]MONEY ORDER**
            **Please make payable to Indra Technology, Inc.

FAX TO: (619) 558-1760
OR MAIL TO:
        Indra Technology, Inc.
        6160 Lusk Blvd, Suite C-203
        San Diego, CA 92121
        Attn: ITGraph Order

THANKS AGAIN FOR YOUR ORDER!

*** Phone Orders: Call (800)735-7776 or (619)452-2652 ***
