DX4WIN Order Form

                      Win95/98/NT/2000/XP



Send to: Rapidan Data Systems

         POBox 2521 Locust Grove, VA 22508

         Telephone: (540) 785-2669  Fax: (540) 786-0658

         Email: sales@dx4win.com  website: http://www.dx4win.com



Name____________________________________  Callsign____________



Street________________________________________________________



City________________________State___  ZIP/Postal code_________



Country ________________________________ Phone________________



Fax___________________ Email__________________________________



DX4WIN Version 7 license (no CDROM)     $89.95        $_______

   (Download from website)

DX4WIN Version 7 Printed User's Guide   $15.00        $_______



UPGRADES:

   From Version 4 or earlier            $50.00        $_______

   From Version 5                       $40.00        $_______

   From Version 6                       $25.00        $_______

   From Version 6 -- New purchase or

       upgrade within last 6 month       N/C



SHIPPING AND HANDLING

   Download from website                 N/C

   Priority mail U.S. / Canada          $ 6.95        $_______

   Airmail Other Areas                  $11.00        $_______



Virginia residents add state tax: (5%)                $_______



        Total (US $ funds only)                       $_______



Method of payment:

    Check__   Money order__  (drawn on US bank only)

    MasterCard__  VISA__  Discover__



Name exactly as on credit card _______________________________

Card Number___________________________________________________

Expiration Date_______________________________________________

CVV2 # ____USA only; last group of 3 digits on signature strip



Signature_____________________________________________________