First Name:
Last Name:
Address 1:
Address 2:
City:
State:	Alabama Alaska Arizona Arkansas California Colorado Connecticut Delaware District of Columbia Florida Georgia Guam Hawaii Idaho Illinois Indiana Iowa Kansas Kentucky Louisiana Maine Maryland Massachusetts Michigan Minnesota Mississippi Missouri Montana Nebraska Nevada New Hampshire New Jersey New Mexico New York North Carolina North Dakota Ohio Oklahoma Oregon Pennsylvania Puerto Rico Rhode Island South Carolina South Dakota Tennessee Texas Utah Vermont Virginia Virgin Islands Washington West Virginia Wisconsin Wyoming
Zip:
Email Address:
Phone Number: (w/area code)
Gender:	Male Female
Date of Birth:	Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 19

System Upgrade Order

	SoHo Upgrade Special ($500)
	Upgrade to 3Ghz Pentium 4 (add $250)
	Additional 256Mb DDR Memory (add $150)
	Upgrade Hard Drive to 120Gb (add $150)
	Add DVD Burner to upgrade (add $150)

Network Promotion Order

	Network 2 Systems ($375)
	Additional Network Device (add $125/device)

Printer Promotion Order

Okidata C5200n Color Laser Printer