"The DittoHead Computer Companion Order Form"

Fill out and mail with your 
payment (19.95 each until Jan 1, 1994) to:

Multi - Media Technologies
5260 Washington
St. Louis, Mo. 63108
(314) 367-6054
Make all Checks Payable to: Multi - Media Technologies"

YOUR NAME    : _______________________________________

BUSINESS    :  _________________________________________

STREET ADDRESS :  ___________________________________________

CITY    :  " _______________________________________________

STATE  :  " __________           ZIP :  " ________________

TELEPHONE NUMBER :  _______________________________________

WHERE DID YOU HEAR ABOUT US :  " _____________________________________________

QUANITY ORDERED ($29.95 ea.) :  ________________________

PAYMENT OPTION (CHECK, CASK OR M.O. OR C.O.D) : " _______________________________





