NAME................................................................................................

SHIPPING ADDRESS........................................................................................................

POST ADDRESS (IF DIFFERENT)................................................................................... ..............................................................

E-MAIL ADDRESS..............................................

FAX NUMBER...........................................

PLEASE STATE THE TYPE OF EQUIPMENT YOU WILL APPLY OUR FORMULAS TO

...........................................................................................................................................

......................................................................................................................................................................................................................................................................................

Enclosed is my (check one) € Personal Check, € Money Order, € Cashiers Check, € International Draft as payment for the following Spica formulas :

....... US Gallons of Spica Blue @ $.......... US........................................$.........................

....... US Gallons of Spica Gold @ $.......... US.......................................$..........................

....... US Gallons of Spica Green @ $.......... US......................................$.........................

....... US Gallons of Spica Red @ $.......... US.........................................$.........................

TOTAL PAYMENT ENCLOSED........................................................$.........................

Total Number of US Gallons Ordered...............................

Mail (post) this completed order with payment to:

THE PARSEC GROUP
General Public Sales
Communications/Computer Center
Post Office Box 207
Powhatan, Virginia, 23139
United States of America
E-mail: parsec@hughes.net
Fax 804-598-9556


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