Micrologic Research Fax # (602) 532-7044
This form can be printed and mailed or
faxed with your order
Billing Information:
Name: _____________________________________________
Title: ____________________________________________
Company: __________________________________________
Division: _________________________________________
Address: __________________________________________
Address: __________________________________________
City: _______________ Zip/Postal Code: ___________
Country: __________________________________________
Tel: ___________________ Fax:_____________________
E-mail ____________________________________________
Shipping Information (If different from billing):
Name: _____________________________________________
Title: ____________________________________________
Company: __________________________________________
Division: _________________________________________
Address: __________________________________________
Address: __________________________________________
City: _______________ Zip/Postal Code: ___________
Country: __________________________________________
Tel: ___________________ Fax:_____________________
E-mail ____________________________________________
Please send me: (circle the information)
1 copy of Bluetooth2002 U.S. $ 1,995
___additional book format at $500 each $________
___additional CD-ROMS at $500 each $________
1 copy of Wireless Data Communication2001 U.S. $ 2,895
___additional book format at $500 each $________
___additional CD-ROMS at $500 each $________
1 copy of Cellular2002 at U.S.
$ 2,895
___additional book format at $500 each $________
___additional CD-ROMS at $500 each $________
Total $________
Please indicate payment method:
Check enclosed payable to Micrologic Research
Wire transfer (call us for account information)
Purchase Order# ________________
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