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Text File  |  1993-08-16  |  5KB  |  63 lines
  1.  ##########################################################################
  2.  #                                                                        #
  3.  #   Smart -N- Easy tm  BAR MITZVAH PLANNER 1.0       Registration Form   #
  4.  #                                                                        #
  5.  ##########################################################################
  6.  #                                                                        #
  7.  #    Company Name _____________________________________________________  #
  8.  #                                                                        #
  9.  #    First Name ____________________ Last Name ________________________  #
  10.  #                                                                        #
  11.  #    Address __________________________________________________________  #
  12.  #                                                                        #
  13.  #    City _________________________ State _______ Zip _________________  #
  14.  #                                                                        #
  15.  #    Day Phone (______) ____________  Night Phone (______) ____________  #
  16.  #                                                                        #
  17.  ##########################################################################
  18.  #                                                                        #
  19.  #    Disk Size  _____ 5.25"   _____ 3.5"                                 #
  20.  #                                                                        #
  21.  #    How did you first learn of this product?                            #
  22.  #                                                                        #
  23.  #    _____ Magazine   _____ Newspaper   _____ Exhibition  _____ Review   #
  24.  #                                                                        #
  25.  #    Received this disk from:_________________________________________   #
  26.  #                                                                        #
  27.  #    What did you like about Smart -N- Easy?  (check all that apply)     #
  28.  #                                                                        #
  29.  #    _____ Performance  _____ Price  _____ Quality  _____ Reliability    #
  30.  #                                                                        #
  31.  #    _____ Recommendation   (other)____________________________________  #
  32.  #                                                                        #
  33.  #    Primary usage in:  _____ Home     _____ Event Planning Business     #
  34.  #                                                                        #
  35.  #    List any Free sample disks you would like to receive with order:    #
  36.  #    _______________________________________________________________     #
  37.  #                                                                        #
  38.  #    _______________________________________________________________     #
  39.  #                                                                        #
  40.  #    _____ Enclosed is payment in check or money order for $29.95        #
  41.  #          plus tax.  Please ship my registered version promptly.        #
  42.  #                                                                        #
  43.  #    _____ Please promptly ship my registered version C.O.D. at          #
  44.  #          $29.95 plus tax and $3.50 C.O.D. charges.                     #
  45.  #                                                                        #
  46.  #    NJ residents please add 6% sales tax.                               #
  47.  #    If ordering outside of The U.S., please add $5.                     #
  48.  ##########################################################################
  49.  #                                                                        #
  50.  #    Credit Card Orders:                                                 #
  51.  #                                                                        #
  52.  #                         We accept VISA & MasterCard.                   #
  53.  #                                                                        #
  54.  #    ____ VISA  ____MasterCard   Card # ______ ______ ______ ______      #
  55.  #                                                                        #
  56.  #                                Expiration Date _____/_____             #
  57.  #                                                                        #
  58.  #    FOR FASTER SERVICE, YOU MAY PHONE-IN ORDERS: 1-800-LUV-MY-PC voice  #
  59.  #                                                  (201) 812-1169 FAX    #
  60.  #                                                                        #
  61.  #  Mail orders to: Automated Systems, PO Box 503, West Paterson NJ 07424 #
  62.  ##########################################################################
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