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Text File  |  2000-04-23  |  1KB  |  54 lines
  1. SanitySoft 
  2. Order Form
  3. (Please Print this page)
  4.  
  5.  
  6. Product                          Bingo Hall   1.0
  7.  
  8. Price                            10.00
  9.  
  10.  
  11. Personal Information:
  12.  
  13. NAME                    __________________________      *
  14.  
  15. Email Address           __________________________      *
  16.  
  17. ADDRESS:                __________________________      * (If Requesting
  18.  
  19.                         __________________________         a CD )       
  20.                                 
  21.                         __________________________ 
  22.                                
  23.                         __________________________                                       
  24.  
  25.                                      
  26. PHONE #                _____ - ______ - __________
  27.  
  28.  
  29.  
  30.  
  31.                 
  32.  
  33.  
  34. CD Request           [     ]  - Please check this box and add 5.00 
  35.                                 to your order if you would like a CD.  
  36.  
  37.  
  38.  
  39. SIGNATURE        ____________________________________________       *
  40.  
  41.  
  42.  
  43.  
  44.  
  45. Please send a check payable to Ray Malone to P.O Box 1485 Hedgesville,
  46. Wv 25427. Once payment is received a registration code will be E-mailed 
  47. to the listed email address and if a CD is requested, it will be
  48. mailed to the address listed above.        
  49.  
  50. * = Required Field  ( if required fields are missing, illegible, 
  51.                       or invalid your order may be delayed or never
  52.                       received  )        
  53.  
  54.