Millennium Computers
Order Form
First Name
Last Name
Address #1
Address #2
City
State
ZIP
Contry
Phone
(format: 111-111-1111)
Processor Speed (select one)
2.5 GHz
3.3 GHz
4.0 GHz
5.5 GHz
Memory (select one)
128 MB
256 MB
512 MB
1024 MB
Drive Size (select one)
60 GB
80 GB
120 GB
Monitor Size (select one)
15-inch
17-inch
19-inch
21-inch
CD-ROM (select one)
24x
32x
48x
64x
72x
DVD Player
--
yes
no
CD Burner
--
yes
no
DVD Burner
--
yes
no
LAN Card
--
yes
no
Internal 56k Modem
--
yes
no
Name on Card
Card Type
Visa
Master Card
Discover
American Express
Card Number
Exp. Date
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Millenium Computers · 414 Wittlow Way · Farley, SD 85312 · 1 (800) 555-2377