AmNet Computers LLC
                       3500 Boston Street, Suite 266
                       Baltimore, Maryland 21224-5701
		       Fax (443) 919-2003


                            ORDER FORM

Product Name ___________________________________________________

Product #    ___________________________________________________

Quantity     ____, ____, ____

First Name   ___________________________________________________

Last Name    ___________________________________________________

Company      ___________________________________________________

Address      ___________________________________________________

City,St,Zip  ___________________________________________________

Country      ___________________________________________________

E-Mail       ___________________________________________________

Day Phone    ___________________________________________________

Night Phone  ___________________________________________________

Fax          ___________________________________________________

Payment Method: MC, Visa, AmEx, Optima, COD, Personal Check (circle one)

Credit Card # _________________________ Exp. Date ______________

Shipping Address (if different from above)

Name          ___________________________________________________

Company       ___________________________________________________

Address       ___________________________________________________

City,St,Zip   ___________________________________________________

Country       ___________________________________________________

Phone         ___________________________________________________

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