LASER DISPLAY CORPORATION
REQUEST FOR QUOTE / ORDER FORM


Customer Reference Number _________ (*Optional)
Date           		;
Company Name		;
Address        		;
City           		;
Prov/ST.       		;
Country        		;
PC/ZIP         		;
Phone          		;
Fax            		;
Contact Name		;
Email Address  		;

Material Manufacturer	;
Material Part Number	;
Quantity		;

Customer Drawing #1	;(File Name - May Be Part Of ZIP)
File Type 		;(Example > .DWG, .DXF, .DOC, .JPG)
Description		;(Modification / Addition)
Additional Material	;(Example > (Color-On-Color - Thickness)
			 *Material May Also Be Specified In Drawing

*Add Files As Needed*

*Add Comments 		;
			;

SPECIAL INSTRUCTIONS FILE NAME ;

Shipping Method		;


***************************************************************
***   This Section For LDC Use Only   *************************

QUOTE/ORDER NUMBER _____________  Customer Ref # _________ 

_________ $ Ea. - Material + Modification
_________ $ Ea. - Shipping & Handling	

Estimated Delivery ; _______________

***************************************************************

***************************************************************
For Ordering Use Only

PO #           		;
Shipping ACCNT#		;(*Optional LDC Shipping / See Quote)
Credit Card#   		;
Visa/MC        		;
Exp. Date      		;xx/xx
PO #           		;

***************************************************************

Please use this document to request quotes.  LDC will return the file with
pricing and delivery sections completed.  To place an order, return the
completed form to LDC including credit card information or purchase order
number (*P.O. Accepted For Pre-Approved Accounts Only).  LDC will confirm 
order and delivery details with a seperate invoice.

DO NOT MODIFY THIS DOCUMENT's FORMAT IN ANY WAY.  USE a SEPARATE order form
for EACH design. ARCHIVE USING PKZIP, 1 Design + Orderform per ZIP.

Enter data to the RIGHT of the ";"
Save as a PURE ASCII FILE - NO WORD PROCESSOR FORMATS

PO numbers are for pre-approved accounts only.
You may include a PO# for reference and it will appear on your invoice.

Only Visa and Master cards are accepted.  AMEX is NOT accepted.
Inspect the accuracy of the Card number and card Expiry Date.
Note: ALL Orders paid by credit card will be invoiced in US FUNDS

FEDEX is our exclusive carrier.  You may include your Fedex Account Number
if you don't want to be invoiced for shipping.  If you have provided a 
FEDEX number there will be a $5.00 S/H fee added to your invoice.