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/ Gold Medal Software 3 / Gold Medal Software - Volume 3 (Gold Medal) (1994).iso / utils1 / cardone.arj / ORDERFRM.TXT < prev    next >
Text File  |  1994-03-01  |  3KB  |  56 lines
  1.                          REGISTRATION/ORDER FORM
  2.  
  3. For credit card or multiple                     For cash or cheque orders
  4. product orders send to                          for CARD only send to
  5.  
  6. ARK ANGLES                                      ERIC RODDA-SOFTWARE
  7. 24 Alexander Ave                                34 Abbeville Tce
  8. Hazelbrook  NSW  2779                           Marion  SA  5043
  9. AUSTRALIA                                       AUSTRALIA
  10. Phone: (047)588100 or Intl+61-47-588100
  11. Fax:   (047)588638 or Intl+61-47-588638
  12. CompuServe: 100237,141
  13.  
  14. From: Name    ___________________________________________________________
  15.  
  16.       Company ___________________________________________________________
  17.  
  18.       Address ___________________________________________________________
  19.  
  20.       Town    ____________________________  State ________  Code ________
  21.  
  22.       Country ___________________________________________________________
  23.  
  24.       Phone   ____________________________  Fax _________________________
  25.  
  26. Where did you obtain or hear about the software? ________________________
  27.  
  28. Computer:      [ ] XT     [ ] AT/286     [ ] 386     [ ] 486     [ ] >486
  29. Memory Size: ____________    Hard Disk Size: __________
  30. Drives:  [ ] 360K 5.25"   [ ] 720K 3.5"   [ ] 1.2M 5.25"   [ ] 1.44M 3.5"
  31. Screen:    [ ] Mono/Herc     [ ] CGA     [ ] EGA     [ ] VGA     [ ] >VGA
  32. Dos Version: _______    Windows Version: _______    OS/2 Version: _______
  33.  ___________________________________________________ _______ ___________
  34. | P R O D U C T  /  L I C E N S E                   | Q T Y | P R I C E |
  35. |___________________________________________________|_______|___________|
  36. |                                                   |       |           |
  37. |___________________________________________________|_______|___________|
  38. |                                                   |       |           |
  39. |___________________________________________________|_______|___________|
  40. |                                                   |       |           |
  41. |___________________________________________________|_______|___________|
  42. |                                                   |       |           |
  43. |___________________________________________________|_______|___________|
  44. | T O T A L                                                 |           |
  45. |___________________________________________________________|___________|
  46.  
  47. [ ] Bankcard    [ ] Mastercard    [ ] Visa    [ ] Cash/Cheque/Draft/Order
  48.  
  49. Credit Card No  _______ _______ _______ _______   Expiry Date ____ / ____
  50.  
  51. Cardholder Name _________________________________________________________
  52.  
  53. Signature       _______________________________   Date __________________
  54.  
  55. Comments:
  56.