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First Name ____________________________ Last Name _____________________________

Company    ____________________________________________________________________

Address1   ____________________________________________________________________

Address2   ____________________________________________________________________

City/Town  ____________________________________________________________________

State      _______  Zip Code  ______________  Country _________________________

Day Phone   ____________________________ Fax # ________________________________

Credit Card; Master Card [ ], Visa [ ], American Express [ ], Discover [ ]

          Card #    _____________________________________________ EX ____/_____

          Signature ___________________________________________________________

Check [ ];  Please remit in U.S. funds drawn on a U.S. Bank.

                                                             Shipping
Quan                 Description                     Price  (USA/ Int)  Total

____ PowerBASIC Gazette                                $0    $0   $0      $0
____ PowerBASIC 3 Demo (TRYPB3.EXE)                    $0    $0   $0      $0
____ FirstBasic Registered Version                  $ 25.00  $4 / $10  ________
____ PowerBASIC 3 for DOS                           $149.00  $6 / $28  ________

____ PowerBASIC Developer Kit for Windows           $149.00  $6 / $28  ________
____ PB/Xtra  (Programmer's Reference Collection)   $ 49.00  $4 / $10  ________
     CDROM ____   3.5 inch disks ____
____ QuickPak Professional for PowerBASIC           $129.00  $6 / $28  ________
____ SoftCode for PowerBASIC (Code Generator)       $ 99.00  $6 / $28  ________
____ SoftDemo and Flash-up Toolbox                  $ 49.00  $4 / $10  ________

Total                                                                  ________

Priority Shipping (USA Only)
        [__] Overnight add $16.00, [__] Second Day add $6.00           ________

        [__] COD's (USA Only) Add $5.00                                _________

        Sales Tax (California Residents Only) @ 7.25%                  ________
                                                                                                                                         Total _________
           PowerBASIC, Inc., 316 Mid Valley Center, Carmel, CA 93923
         408-659-8000 voice, 408-659-8008 Fax, 800-780-7707 orders only
              75300,1742 CompuServe, sales@powerbasic.com Internet