NOTE:  Only fill out this order form if you have a SupraExpress or Simple
       Internet 288 and are upgrading to the 33.6 standard.
																
	NAME:________________________________________________________
								
	ADDRESS:_____________________________________________________
									
	CITY:___________________STATE:______________ZIP:_____________

        COUNTRY:___________________________
			
	TELEPHONE:______________  FAX:_______________
	MODEM SERIAL #:		
		
	DESCRIPTION					 QTY          COST

	SupraExpress or Simple Internet 28.8 External	______	  x $10.00    _________
	SupraExpress or Simple Internet 28.8 Internal   ______    X $10.00    _________
	
	SPECIFY ROM TYPE NEEDED (A,B,C,D,E,F,G,H,I)			      _________						
     ROM type must be specified in order to process the order,
     if unsure of the type you need refer to the upgrade program for instructions.								
		
							
	 Shipping Charges per ROM: 								
		 UPS Next Day add $19.95 (USA),  $29.95 (Canada)	        ________
		 UPS Ground add $9.95 (USA), $16.95 (Canada)			________
		 International shipping add $17.95 (U.S. Airmail)		________
		 Sales Tax (WA State residents add 7.6%)			________

								  GRAND TOTAL:__________
						
	METHOD OF PAYMENT:
									
	MasterCard ______ Discover Card _____

	Visa _____ Money Order _____	
	
	Credit Card Number:______________________________________Exp.___________
		
	Cardholder Signature:
									
	Fax or mail the completed upgrade form to :
		
		Diamond Multimedia Communications
		Attn:  33.6 ROM Upgrade	
		312 SE Stone Mill Drive, Suite 150
		Vancouver, WA 98684  USA
		Fax:  (360) 604-1401	Phone: (800) 727-8772