AMIC GAMES ORDER FORM [WWW] www.amicgames.com *** Please Type or Print Clearly *** Name _________________________________________________________ Address ______________________________________________________ City __________________ St./Prov. ___________ ZIP/Code _______ Country _________________ Email ______________________________ *** Mark your choice below *** All prices are in US Dollars, shipping included greenface the Virtual Reality [ ] Shipped via email to the email address above ($19.95) [ ] Shipped via first class mail on CD-ROM ($24.95) Xantia Elite [ ] Shipped via email to the email address above ($24.95) [ ] Shipped via first class mail on CD-ROM ($29.95) SUBTOTAL: $__________ California State residents add sales tax: $__________ (tax must be added for CD-ROM orders only) TOTAL ORDER: $__________ Make checks payable to "Reg Now". [ ] Cash (US Dollars only) [ ] Check (Must be in US Dollars and drawn against a US bank) [ ] Money Order [ ] Credit Card (VISA / MasterCard / Discover accepted) Name on Card _____________________________________________ Card Number ___________________________ Exp Date ____/____ Signature ________________________________________________ Mail to: Dexterity Software P.O. Box 571961 Tarzana, CA 91357-1961 USA or Fax to: 1-530-579-7241 (Credit Card Orders Only) *** Thank you for your order! ***