HomeFax
Order Form for
Pixel Pageant Screen Saver Lab
Print
this form, fill it in and FAX it to us at
USA — (602) 916-1495
Or copy to a text editor, fill it in and E-Mail to:
Please let us know
how you found us -- magazine, mailer, Internet, referral, etc.
Our marketing department appreciates the time you take to fill in this
section.
It will help us in our future efforts. Thank You!
How did you find us?
_________________________________________________________
( Please print in clear, legible type if you are faxing your order )
_________________________________________________________
Last Name:
_________________________________________________________
_________________________________________________________
Address #1:
_________________________________________________________
_________________________________________________________
City, State, Zip Code:
_______________________________
Country:
_______________________________
Phone #:
_________________________________________________________
Fax #:
_________________________________________________________
E-Mail Address:
_________________________________________________________
Please charge me for the following:
____ (Qty) Pixel Pageant
"Unlimited" — $89 each
____ (Qty) Optional
CD-Rom — $39 each
____ (Price includes Handling and Air Mail)
Method of Payment:
Visa ____ MasterCard ____ (Please tick)
Name on Card ___________________________________________________
Account Number _____________________________ Exp. Date ___________
CVC Number ____ (Last
three digits of number printed on reverse side of Card)
CVC Number ____ (Visa and Master Credit Cards
ONLY)
Authorized Signature _______________________________
Please send completed form to:
------- E-mail:
------- Fax: (USA) - (602) 916-1495
-------
Or
mail to:
------- Pixel
Pageant
------- 16 Marschall Place
------- Stamford
------- Connecticut 06905
------- USA
An unlock code
to register Pixel Pageant Screen Saver Lab
will be supplied to you on receipt of payment.
----------------------------------------------------------------------------------------------------------
Pixel Pageant and Screen Saver Lab are trademarks of Screen Saver Lab
Macromedia Flash and Director are trademarks of Macromedia, Inc
Windows and PowerPoint are trademarks of Microsoft Corporation
----------------------------------------------------------------------------------------------------------
