----------------------------------------------------------------------------- PiXEL STORM ENTERTAINMENT Address : 11135 23A Ave. Edmonton, Alberta Canada T6J-4W5 Internet : orders@sy-systems.com Web : http://www.sy-systems.com ----------------------------------------------------------------------------- Please fill out the appropriate sections of the form and mail it to us. Please include correct information to ensure proper handling of order. ============================================================================= -Canadian Orders- ----------------------------------------------------------------------------- MegaMotion (TM) Copies Required:____ x ($34.99 CDN each) = SubTotal:________ PlasmaZone (TM) Copies Required:____ x ($24.99 CDN each) = SubTotal:________ ****** Order both games and save $5.00 ******* Pack (both games) Copies Required:____ x ($54.98 CDN/pack) =SubTotal:________ Shipping & Handling :$5.00_______ Total Amount enclosed (Prices include GST) :$___________ Payment Method: ( ) Cheque ( ) Money order Cheque must be in Canadian funds and drawn on a Canadian Bank otherwise send a Money Order. ----------------------------------------------------------------------------- ============================================================================= -US and International Orders- ----------------------------------------------------------------------------- MegaMotion (TM) Copies Required:____ * ($24.99 USD each) = SubTotal:________ PlasmaZone (TM) Copies Required:____ * ($19.99 USD each) = SubTotal:________ ****** Order both games and save $5.00 ******* Pack (both games) Copies Required:____ x ($39.98 USD/pack) =SubTotal:________ Shipping & Handling (International add an additional $3) :$4.00________ Total Amount enclosed: :_____________ Payment Method: ( ) Cheque ( ) Money order Cheque must be in US funds and drawn on a US Bank otherwise send a Money Order. ----------------------------------------------------------------------------- ============================================================================= -Information- ============================================================================= Please be sure to fill this form accurately. Name :____________________________________________________ Address :____________________________________________________ ____________________________________________________ City, State/Province:____________________________________________________ Postal Code (ZIP) :_____________________________ Country :_____________________________ Phone :_____________________________ Where did you obtain this demo? ____________________________________________ Comments/Questions ? :______________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ ____________________________________________________________________________ Thank you for ordering from PiXEL STORM ENTERTAINMENT. We appreciate your business and look forward to giving you more quality products in the future. NOTE: All prices and products in this form are subject to change without prior notice.