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Text File  |  1995-10-20  |  4KB  |  75 lines
  1. **************************************************************************
  2. *                                                                        *
  3. *                        Professional Carrier - v1.2                     *
  4. *                   Copyright 1995 by BlueCollar Software                *
  5. *                                                                        *
  6. *                         Published exclusively by:                      *
  7. *                           RMH Computer Services                        *
  8. *                                PO Box  657                             *
  9. *                         Beech Grove IN 46107-0657                      *
  10. *                              (317)  782-9903                           *
  11. *                                                                        *
  12. **************************************************************************
  13.  
  14.                                  ORDER FORM
  15.  
  16. --------------------------------------------------------------------------
  17.  Send registration     RMH Computer Services           [  you can call   ]
  18. form and payment to:   PO BOX 657                      [  317-782-9903   ]
  19.                        BEECH GROVE, IN 46107-0657      [  to order via   ]
  20.                        USA                             [ VISA/MasterCard ]
  21. --------------------------------------------------------------------------
  22.  
  23.  I have enclosed (US Funds) for the following product:
  24.          [ ] Professional Carrier -  $59.00  ................... $_____
  25.  
  26.  Indiana residents must add 5% State sales tax ................. $_____
  27.  
  28.  Shipping/Handling ............................................. $_____
  29.    [ ] USA residents please add .............. $3.00 S/H
  30.    [ ] Canada/Mexico residents please add .... $5.00 S/H
  31.    [ ] Other residents please add ............ $8.00 S/H
  32.  
  33.                                         Total .................. $_____
  34.  
  35.  
  36. PLEASE TYPE OR PRINT (all information will remain confidential)
  37.  
  38. Name...: __________________________________________________________
  39.  
  40. Address: __________________________________________________________
  41.  
  42.        : __________________________________________________________
  43.  
  44.        : __________________________________________________________
  45.  
  46. Phone Number (Required)..: ___________________    Sales Code: PC120ADN
  47.  
  48. Do you have a CompuServe Acct? [y/n]: ____  If yes, ID# _______________
  49.  
  50. I would like to receive:  [___] 3-1/2" disks (720k)
  51.                           [___] 5-1/4" disks (360k)  
  52.  
  53.  
  54.  
  55. CREDIT CARD ORDERS
  56. ------------------
  57.  
  58. For fast Credit Card (MC/VISA) ordering, please call us at 317-782-9903. 
  59. Or, you can provide the information (including your signature!) in the 
  60. space below. *ALL* spaced must be completed:
  61.  
  62.    +------------------------------------------------------------------+ 
  63.    | We can accept MasterCard or Visa credit card payments.  Fill out | 
  64.    | the following ONLY if you are making payment by MC or Visa.      | 
  65.    |                                                                  | 
  66.    | MasterCard [_]    Visa [_]     Number [____  ____  ____  ____]   | 
  67.    |                                                                  | 
  68.    | Name on the Card [_____________________________________________] | 
  69.    |                                                                  | 
  70.    | Expires [_______]  Signature (*)________________________________ | 
  71.    +------------------------------------------------------------------+ 
  72.             (*) NOTE: This *REQUIRES* a hand-written signature! 
  73.  
  74.  
  75.