MINI-500 ORDER FORM
(TEXT VERSION — Please print & use when MAILING your order)


Order By Mail: Print out this order form, and send it along with US FUNDS check or Money Order, or credit card information to:

Vortech, Inc.
PO Box 511-W
Fallston, MD 21047

Order By Phone (3pm to 7:00pm EST): Have your credit card on hand and call:

410-668-2757



Your e-mail address: ________________________________________________

Your Name: ______________________________________________________

Address:_________________________________________________________

City: ____________________________________________________________

State / Province: ______________ Zip / Postal Code: ______________________

Country (if not USA) _______________________________________________

Phone: _______________________________ Fax:____________________________


                                             Please send me (prices include postage):

___ Mini-500 Manuals @ $88 U.S.,  $109 foreign: $______________

SUB-TOTAL $_____________

SALES TAX (Maryland residents add 6%)_____________

All remittances must be in US FUNDS

TOTAL $ _____________


CREDIT CARD INFORMATION

(We accept VISA, MASTERCARD, AMERICAN EXPRESS & DISCOVER)

CARD TYPE (check one)  ___VISA  ___MASTERCARD  ___AMEX   ___DISCOVER

CARD NUMBER: ______________________________________________________

EXPIRATION DATE: (in the form mm/yy; such as, 08/27): ____________________  3-DIGIT SECURITY CODE (CVV): ___________

NAME APPEARING ON CARD: _________________________________________


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