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dr-reg.doc
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Text File
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1992-10-31
|
5KB
|
61 lines
+-----------------------------------------------------------------------------+
| DUNGEONS OF DRAKKLOR v4.0 Registration Form (1C) Date: / / |
+-----------------------------------------------------------------------------+
| Specify diskette size [ ] 3.5" [ ] 5.25" |
+------------------------------------+----------------------------------------+
| Mail your orders/responses to: | [ ] $14.95 Basic Registration |
| | |
| WestWorld Computer Services | [ ] $ 3.00 Printed Map Booklet |
| 3755 Avocado Blvd. | (only with registration) |
| Suite 304 | [ ] ( ) CA res. 7.75% sales tax |
| La Mesa, CA 91941-7301 | |
+------------------------------------+ [ ] $ 3.00 Shipping - All orders |
| FAX orders only (no responses) to: | |
| | [ ] $ 5.00 Additional handling charge |
| (619) 558-2225 (24 hours) | for orders outside the USA |
+------------------------------------+ and Canada. |
| To order by phone call: | |
| | ================ |
| (800) 995-1605 (24 hours) | | | Total enclosed |
+------------------------------------+ ================ |
| Outside of the US call: | |
| | ** All payments must be in US ** |
| (619) 685-7291 (24 hours) | ** funds drawn on a US Bank ** |
+------------------------------------+----------------------------------------+
| METHOD OF PAYMENT: All prices are in US Dollars. Please include applicable |
| taxes and shipping cost. |
| |
| [ ] Check/Money Order (payable to WestWorld Computer Services) |
| [ ] Visa [ ] Master Card |
| |
| | | | | | | | | | | | | | | | | | | | | |
| Account# |--|--|--|--|--|--|--|--|--|--|--|--|--|--|--|--| Exp Date |--|--| |
| |
| Authorized Signature |
| ------------------------------------------------------ |
| Daytime Phone |
| ------------------------------------------------------ |
| (Signature and phone required for credit card orders) |
+-----------------------------------------------------------------------------+
| SHIP TO NAME/ADDRESS (please print) | BILL TO NAME/ADDRESS (if different) |
| | |
| ------------------------------------ | ------------------------------------ |
| | |
| ------------------------------------ | ------------------------------------ |
| | |
| ------------------------------------ | ------------------------------------ |
| | |
+-----------------------------------------------------------------------------+
| | National BBS Name/Forum : |
| +---------------------------------------------------------+
| Where did you get | Local BBS Name : |
| get your copy of | City / State : |
| DUNGEONS OF | Tel# : |
| DRAKKLOR? +---------------------------------------------------------+
| | Distributor Name : |
| +---------------------------------------------------------+
| | Friend / Associate (Y/N) : |
+-----------------------------------------------------------------------------+
| All registered users will automatically be entered in our software drawings |
+-----------------------------------------------------------------------------+