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Text File  |  1996-09-27  |  2KB  |  49 lines
  1.  
  2.  
  3. Registration ﾂ 
  4. Form
  5.  
  6. ﾂ 
  7.  
  8.  
  9. Mail, fax, or e-mail form to: 
  10.  
  11. ELS, Inc.         
  12. 5200 NW 43rd Street, Ste 102-323                                                       
  13. Gainesville, Florida 32606
  14.  
  15. Fax: (352) 375-5679           Info: (352) 375-0558         E-mail: elstech@elsinc.com
  16.  
  17. Register Online at our Web Site:   http://www.elsinc.com
  18.  
  19. Please register me for:
  20.  
  21.     ______ChatNet Personal Edition    ..........................$25
  22.     ______ChatNet 10 User License    ..........................$99
  23.     ______ChatNet 50 User License    ........................$249
  24.     ______ChatNet 250 User License    ......................$499
  25.  
  26. Order Total:  $_____________      (Florida residents add 6% sales tax)
  27.  
  28. User Name :______________________________________________________________
  29.  
  30. Address: ________________________________________________________________
  31.     
  32. City:    _________________________State: __________      Zip:    _______________________
  33.  
  34. Country:_____________________     Daytime Phone: (_____    )    ________________________
  35.  
  36. Fax Number: (____    )    ______________ E-mail Address: _____________________________
  37.  
  38. Method of Payment:
  39.     _____Check or Money Order (US funds) enclosed payable to: ELS, Inc.
  40.     _____Charge my credit card:   MasterCard _______     VISA ________    
  41.  
  42. Card Number:_____________________________________     Exp. Date: ______________    
  43.  
  44. Name on Card:    ___________________________________________________________
  45.  
  46. Cardholder Signature (required):    ______________________________________________
  47.  
  48. Please send my registration information via:  ___e-mail   ___fax  ___mail.
  49.