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Text File  |  1994-01-26  |  2KB  |  53 lines
  1.          REGISTRATION INVOICE FOR HIDIMG (C) SHAREWARE
  2.          ---------------------------------------------
  3. Make all checks/money orders out to or call with credit card order:
  4.                      FHS Supply Inc.
  5.                      PO Box 9
  6.                      Clover, SC 29710
  7.                      USA
  8.                      1-800-742-8484  or  1-803-222-7488
  9.  
  10. Please fill out the form below:
  11.  
  12. Name:______________________________________________________________
  13.  
  14. Company:___________________________________________________________
  15.  
  16. Address:___________________________________________________________
  17.  
  18. City:__________________________ State:__________ Zip:______________
  19.  
  20. Country:_______________________ Telephone #:_______________________
  21.  
  22. EMail Address:_____________________________________________________
  23.  
  24. Version # of HIDIMG you are currently using:_______________________
  25.  
  26. Where did you obtain your copy of HIDIMG?__________________________
  27.  
  28. Prices are shown in US Dollars. Please ensure that your check is in
  29. US Dollars, drawn on a US bank.  Checks will be held until cleared.
  30.  
  31. Disk Size:  _____ (5 1/4" 1.2M)      _____ (3 1/2" 1.44M)
  32.  
  33. Quantity                          Price Ea.        Total
  34.  
  35. _______    HIDIMG Program         $24.95           _____
  36.  
  37.          SC Residents add 5%       $1.25           _____
  38.  
  39.          Shipping and Handling     $5.00           _____
  40.  
  41.                               Total Enclosed _____________
  42.  
  43. Credit Card orders (VISA/MasterCard/Discover/American Express):
  44.  
  45. NAME ON CARD:___________________________________________
  46.  
  47. Card #:_________________________________________________
  48.  
  49. CARD EXPIRATION DATE:___________________________________
  50.  
  51. Authorizing Signature:__________________________________
  52.  
  53. Note: Prices are for SINGLE-COMPUTER licenses.