TO:   AnesthesiaGUIDE                                 DATE: ______________
      P.O. Box 5189
     Santa Rosa, CA  95402-5189


FROM: NAME ________________________________________________  Title: _________

      INSTITUTION ___________________________________________________________

      ADDRESS _______________________________________________________________

              _______________________________________________________________

      CITY    ______________________________ STATE ______   ZIP _____________

      COUNTRY ___________________________________________


Please send _____ single-user copy(-ies) of the AnesthesiaGUIDE @ $169.95 each.

Please send _____ institutional user pack(s): 
          [2 installation disks with 10 workstation licenses] @ $1,199.95 each.


DISK FORMAT:   [] Macintosh      [] Windows (available late 1995)


Sub-Total for Software:         $ __________
Sales Tax (Calif. @ 8%):        $ __________
Shipping (per order):           $       4.00 (US$10.00 outside USA)


TOTAL FOR PURCHASE:        $ _________



METHOD OF PAYMENT:	[] Check    [] Money Order
			[] International Money Order (U.S. $ please)