This is an explanation of the purpose of the form ...
Please provide the following contact information:
Name Title Organization Street address Address (cont.) City State/Province Zip/Postal code Country Work Phone Home Phone FAX E-mail URL
Please provide the following product information:
Product Name XLucent Series 1 XLucent Series 2 Complete System Modems Motherboards Hard Disk Drives 3.5" Floppy Disk Drives Monitors Sofware Other
Please provide the following ordering information:
QTY DESCRIPTION BILLING Purchase order # Account name SHIPPING/DELIVERY ADDRES Street address Address (cont.) City State/Province Zip/Postal code Country