V.92/V.44 Modem Order Form

Specifications: PCI, 56K, V.92/V.44 Lucent modem with Voice Mail software, modem-on-hold, data compression

Please enter the following information:

                   Name: 
        Organization:   (optional)
 Street address #1:
 Street address #2: (if needed)
       City/State/Zip:
      Phone number: (optional)
                 FAX #: (optional)
     E-Mail address: (optional, used only to notify you of confirmation of order)

$22.00 will be charged to the below credit card. No charge for shipping. For shipping to a Virginia address, a 4.5% sales tax will be added.

Credit card information:        Visa       Master Card
           Credit card number:
Credit card expiration date:
 Name as appears on card:

Comments:

This page has been accessed times since September 11, 2001

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