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ORDER.FRM
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1990-11-18
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2KB
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65 lines
ActaeOn Version 1.60 US Registration Form
-----------------------------------------------------------------
Send Card details to:
Jon Clempner
20, Norleigh Road
Northenden
Manchester
M22 4AZ or CompuServe 100013,57
ENGLAND or by phone to +44 61 998 8592
-----------------------------------------------------------------
Quan Item Price Total
___ ActaeOn registration ........... @ 34.95 dollars ________
___ 3 1/2 inch disk supplement ...... @ 2.00 dollars ________
___ Shipping & Handling (Air Mail) ... @ 5.00 dollars ________
Total ________
Visa/Master Card (Access) accepted. Checks or Money orders can
only be accepted if paid in UK Pounds sterling drawn on a UK
bank.
-----------------------------------------------------------------
Check enclosed ____ Visa ____ Master Card ____ (tick as approp.)
Name on Card ________________________________________________
Card Number ________________________________ Expires ________
Name_______________________________________________________
Company_______________________________________________________
Address_______________________________________________________
_______________________________________________________
_______________________________________________________
Phone_________________________ Bus.________________________
Where did you obtain ActaeOn?
_______________________________________________________
ActaeOn Serial Number _______________________________________
Comments_______________________________________________________
_______________________________________________________
_______________________________________________________
_______________________________________________________
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