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Text File  |  1993-12-24  |  2KB  |  61 lines
  1.  
  2.  
  3.                           ZDIFF 1.4 REGISTRATION FORM
  4.  
  5.                           Date : ______/______/______
  6.  
  7.     TO:
  8.                Christophe Dubourg
  9.                23, rue Victor Hugo
  10.                78370 PLAISIR
  11.                FRANCE
  12.  
  13.     ----------------------------------------------------------------
  14.     FROM:
  15.  
  16.                Name: _______________________________________________
  17.  
  18.       Compuserve Id: _______________________________________________
  19.  
  20.           [Company]: _______________________________________________
  21.  
  22.             [Title]: _______________________________________________
  23.  
  24.             Address: _______________________________________________
  25.  
  26.                      _______________________________________________
  27.  
  28.               State: ______________________ Zip Code: ______________
  29.  
  30.             Country: ______________________ Phone: _________________
  31.  
  32.  
  33.  
  34.     I would like the following name appearing on my registered ZDiff
  35.  
  36.     splash screen :  _______________________________________________
  37.  
  38.     (if left blank, you name will be displayed, along with your
  39.      registration number)
  40.  
  41.  
  42.  
  43.     ----------------------------------------------------------------
  44.     Please check the appropriate box(es), and fill the fields below:
  45.  
  46.  
  47.     [ ]  ZDiff on 1 computer ____________________________  = $____10
  48.  
  49.     [ ]  ZDiff on 2 to 10  computers ________  $7 X _____  = $______
  50.  
  51.     [ ]  ZDiff on 11 to 100 computers _______  $6 X _____  = $______
  52.  
  53.     [ ]  ZDiff on 101 to 200 computers ______  $5 X _____  = $______
  54.  
  55.     [ ]  ZDiff on 201 or more computers _________________  = $__1000
  56.  
  57.  
  58.                                                     TOTAL  = $______
  59.  
  60.  
  61.