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register.doc
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1993-03-04
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1KB
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30 lines
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Your Name: ______________________________________________
Your Company Name: ______________________________________________
Your Mailing Address: ______________________________________________
______________________________________________
______________________________________________
Floppy Disk Size: ( )3.5" High Density ( )3.5" Low Density
( )5.25" High Density ( )5.25" Low Density
Number of Copies: _______ ┌──────────────────────────────────────────┐
│ Prices: 1 Copy-$25, 2-5 Copies-$22 each │
│ 6-10 Copies-$20 each, 11 or more │
│ copies $19 each. │
Total Amount Enclosed: $______ └──────────────────────────────────────────┘
------------------------------------------------------------------------------
Make your check or money order payable to: Russell Holloway.
The mailing address is: Russell Holloway
305 Lindenhurst Drive
Apartment 1138
Lexington, KY 40509