
                     
  DLTYPES v1.0.9 Order Form:
                     

  Please send this form together with Payment to the following address.
     
                       D. Lawlis
             Mail      PO BOX 796  
                       Bedford TX 76095-0796

                       or

             EMail     dlawlis@airmail.net  

                       or
  
             Fax       1-817-354-4925  

  
  DLTYPES v1.0.9 personal license fee is $15.00 (US Dollars Only).


    Name ___________________________________________________________

  
    Company Name____________________________________________________


    Address_________________________________________________________


    City__________________________________________Zip_______________


    Phone_____________________________Fax___________________________


    E-Mail Address__________________________________________________



   Mastercard/Visa Information:



   Name as appears on Credit Card___________________________________

   Credit Card Number_______________________________________________

   Expiration date__________________________________________________
  
   Todays Date_______________Signature______________________________ 