
Order for:        MI/X (MicroImages X Server) version 2.0

Price:            $25.00 US


Machine ID:       $@........@$

Name (required):  _______________________________________________________

email (required): _______________________________________________________

Organization:     _______________________________________________________

Address:          _______________________________________________________

                  _______________________________________________________

                  _______________________________________________________

Phone:            _______________________________________________________

FAX:              _______________________________________________________


Payment may be made via credit card or check in the amount listed above
and payable to MicroImages.  For credit card orders provide the following
information:

Card Number:  ___________________________  expiration: ______________

Name on Card: _______________________________________________________

Signature:    _______________________________________________________

Circle One:   VISA   MasterCard   American Express   Discover


Please return this order form to MicroImages by FAX or mail to the
address below.  Please do not send credit card orders by email for
security reasons.

Upon receipt of payment by MicroImages, an authorization code allowing
continued use of the product will be sent to the email address listed above.


MicroImages, Inc.                FAX:   (402) 477-9559
201 North 8th Street             Sales: (402) 477-9554
Lincoln, NE  68508-1347  USA     Web:   www.microimages.com

