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Text File  |  1995-11-14  |  5KB  |  87 lines
  1.  
  2.  REGISTRATION
  3.  ------------
  4.                                                                           
  5.  CyberCom v1.50
  6.  Copyright (C) 1995, Megalomania Software
  7.  
  8.  
  9.  (Europe Registrations)
  10.                        
  11.  
  12.  DIDDI'S DEN DARMSTADT
  13.  Karlstrasse 59
  14.  64285 Darmstadt
  15.  Deutschland/Germany
  16.  PHONE +49-6151-26438
  17.  FAX   +49-6151-151436
  18.  BBS   +49-6151-26422   28.8k vFC
  19.        +49-6151-282622  64.0 ISDN
  20.        +49-6151-282623  64.0 ISDN
  21.  
  22.  HOW TO REGISTER:
  23.  
  24.  - If you are living in Europe please complete this form in its entirety
  25.    from top to bottom. German users please check seperate registration form.
  26.  
  27.  - Print this form and send it to DIDDI'S DEN DARMSTADT with cheque or
  28.    funds enclosed.
  29.  
  30.  - When your registration has been received and verified you will be sent
  31.    a registration code which will enable all registered features and allow
  32.    you to continue using CyberCom for as long as you wish.
  33.  
  34.  
  35.  
  36.   CYBERCOM v1.50 - REGISTRATION FORM:
  37.  
  38.     PERSONAL INFORMATION                                                     
  39.                                                                              
  40.   Company Name______________________________________ (Leave Blank if None)   
  41.                                                                              
  42.   BBS Name__________________________________________ (Leave Blank if None)   
  43.                                                                              
  44.   Contact_________________________________________________________________   
  45.             (Use your real name: FIRST LAST, i.e. MICHAEL MUSTERMANN)        
  46.                                                                              
  47.   Title________________________________ and/or [_] System Operator (SysOp)   
  48.                                                                              
  49.   Voice Phone (____)____-_____                 Data Phone (____)____-_____   
  50.     Fax Phone (____)____-_____               Data Phone 2 (____)____-_____   
  51.                                                                              
  52.   Street__________________________________________________________________   
  53.                                                                              
  54.   Suite/PO Box/Apt/Rt/Ms__________________________________________________   
  55.                                                                              
  56.   City____________________________ Stat/Province__________________________   
  57.                                                                              
  58.   Postal Code_________ Country: __________________________________________   
  59.                                                                              
  60.   Internet EMAIL Address: ________________________________________________   
  61.                                                                              
  62.                                                                              
  63.  
  64.     PAYMENT INFORMATION                                                      
  65.                         Select Form of Payment                               
  66.                                                                              
  67.        [_] Eurocheque     [_] Cash     [_] VISA     [_] DINERS CLUB          
  68.                                                                              
  69.   No. of Copies    Pricing/Copy                                              
  70.        1           DM 79.00                                                  
  71.      2 - 9         DM 69.00     ORDER:                                       
  72.     10 - 24        DM 65.00                                                  
  73.     25 - 49        DM 62.00     No of Copies: _____ @ DM ___ =  DM ____      
  74.     50 - 99        DM 60.00                                                  
  75.    100 - 149       DM 57.00                   Total Enclosed =  DM ____      
  76.    150 - 199       DM 54.00                                                  
  77.                                                                              
  78.     Please do not send Eurocheques in foreign currency. All cheques payable  
  79.     to DIDDI'S DEN DARMSTADT.                                                
  80.                                                                              
  81.     Credit Card Number:_____________________________ Expiry Date:__________  
  82.                                                                              
  83.     Credit Card Holder:____________________________________________________  
  84.                                                                              
  85.   Signature (If this form is sent by mail)_________________________________
  86.  
  87.