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Text File  |  1989-10-26  |  2KB  |  65 lines
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  6.                                Registration Form
  7.        
  8.        
  9.                            Omni Software Associates
  10.                                  15027 Watkins
  11.                           La Mirada, California 90638
  12.                                 (714) 521-6286
  13.        
  14.        
  15.        Company Name:       ____________________________________________
  16.        
  17.        Name:               ____________________________________________
  18.        
  19.        Address:            ____________________________________________
  20.        
  21.                            ____________________________________________
  22.        
  23.        City, State, Zip:   ____________________________________________
  24.        
  25.        Country:            ____________________________________________
  26.        
  27.        Phone:              ____________________________________________  
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  29.        
  30.        
  31.               ___ Source Code  @ $100.00 USD       $________._____
  32.               ___ Registration @ $ 25.00 USD       $________._____
  33.                   Shipping (Outside USA) $5.00 USD $________._____
  34.                   Shipping (USA)         $3.50 USD $________._____
  35.                                        TOTAL ------>________._____
  36.        
  37.        
  38.               Payment By:    ( ) Check #____________
  39.        
  40.                              ( ) Money Order
  41.        
  42.                              ( ) Cash
  43.        
  44.        
  45.             Personal  and  Company Checks Accepted. All checks  must  be 
  46.        drawn  against  a  US Bank and payable in US  Dollars.   For  all 
  47.        orders  please allow four to six weeks for  delivery.   Personnel 
  48.        checks must be cleared by the bank before order is sent!  
  49.        
  50.             I  the  undersigned to hereby agree to the above  terms  and 
  51.        conditions.   I hereby enclose the specified amount as  indicated 
  52.        above.
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  55.        
  56.         ___________________________________________   ________________
  57.                          Signature                          Date
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