                                   U.S. Robotics s.a.
                                   CityParc - 3 Rue Lavoisier
                                   59650     Villeneuve d'Ascq
                                   France
                                   Tel : +33 20 47 08 08
                                   Fax : +33 20 05 32 40
                                   BBS : +33 20 05 32 41
                                         (2:322/9.1@fidonet)
                                 
                                 
                    V32Terbo UPGRADE ORDER FORM
                                 
                                 
CUSTOMER INFORMATION :
======================================================================
Last Name :______________________ First Name :________________________

Company :________________________ Phone :_____________________________

Street Address (No PO Box please) :___________________________________

City :_________________ Zip/Postal code :______________

Country :_______________________VAT # :___________________

BBS # :_______________________Fidonet adress :_____________________


PAYMENT INFORMATION:(Please circle)
=======================================================================
*  Visa  Eurocard/MasterCard    Carte Bleue

    Card # :_____________________________Exp. date :_________

    Card holder name :____________________

*Bank Check / Eurocheque . 
 (Please mail this order form back with your payment)

*Wire Transfer : Please call.

MODEM INFORMATION :
======================================================================
The information requested below is included in the ATI7 screen  of
your  modem. Please complete ALL  items correctly -Your order WILL
NOT be processed if details are missing.

Product type    :____________________

Options         :____________________

Fax Options     :____________________   (if applicable)

Supervisor date :____________________

DSP date        :____________________

Supervisor rev  :____________________

DSP rev         :____________________

Serial number   :______________________________________


UPGRADE INFORMATION :
=====================================================================
Sysop pricing : Y / N   Express shipment: Y / N   Lab Upgrade : Y / N
            see conditions in upgrade announcement
