Pocket Technologies LTD Order Form To print this order form,
click on Print Topic in the pull down menu.

Please be sure to print clearly! Prices guaranteed through February, 1999.

To Pocket Technologies
19 HaArava St.
Ginot Shomron 44853
Israel
Fax: +972-9-7941208

Order form

[ ] PocketBase $39.00
[ ] SuperBase $39.00
[ ] Package deal (PocketBase and SuperBase) $58.00
[ ] SuperBase and PocketBase Hebrew $288.00
[ ] SuperWorks(DOS) $88.00
[ ] SuperWorksPT(DOS) $88.00

Total Payment:

$

Name: _________________________________Date:__________________

Organization:__________________________________________________

Address:______________________________________________________

City, State, Zip:_________________________________________________

Country:______________________Phone:___________________________

Fax:_________________________Email:____________________________

[ ] Payment by Credit card:

[ ] Visa
[ ] MasterCard
[ ] American Express
[ ] Diner's Club

Credit card number: _________________ Expiration date_______

[ ] Check Enclosed

Signature: ___________________