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Text File  |  1993-06-24  |  5KB  |  67 lines
  1. +----------------------------------------------------------------------------+
  2. |   KWQ Mail/2 Registration Form                                             |
  3. |                                                                            |
  4. |                                                                            |
  5. |   Please send your registration information (this form filled out) and     |
  6. |   a check or money order for $25 to the following address:                 |
  7. |                                                                            |
  8. |                       Kurt Westerfeld                                      |
  9. |                       7935 Tyson Oaks Circle                               |
  10. |                       Vienna, Virginia 22182                               |
  11. |                                                                            |
  12. |   Please make all checks out to "Kurt Westerfeld."                         |
  13. |                                                                            |
  14. |   Virginia residents add 4.5 percent sales tax ($25.00 + $1.13) = $26.13.  |
  15. |                                                                            |
  16. |   International orders can only be accepted if checks are drawn on an      |
  17. |   AMERICAN bank.  Sorry, at this time foreign support is limited.          |
  18. |                                                                            |
  19. |----------------------------------------------------------------------------|
  20. |                                                                            |
  21. |   Your Name:   _______________________________________________________     |
  22. |                                                                            |
  23. |   Address:     _______________________________________________________     |
  24. |                                                                            |
  25. |                _______________________________________________________     |
  26. |                                                                            |
  27. |   City:        ________________________________  State: ______________     |
  28. |                                                                            |
  29. |   Zip or Postal Code:  _________________      Country:  ______________     |
  30. |                                                                            |
  31. |                                                                            |
  32. |   OPTIONAL:  (To be used in case of support needs)                         |
  33. |                                                                            |
  34. |   Home Phone:  ____________________   Work Phone:  ___________________     |
  35. |                                                                            |
  36. |   Email:       _______________________________________________________     |
  37. |                                                                            |
  38. |----------------------------------------------------------------------------|
  39. |                                                                            |
  40. |   The following information is optional and will only be used for          |
  41. |   interesting tidbits of trivia:                                           |
  42. |                                                                            |
  43. |                                                                            |
  44. |   Are You a Sysop of a BBS?   Yes ___  No ___    Phone:  _____________     |
  45. |                                                                            |
  46. |   How long have you used OS/2?  ____________                               |
  47. |                                                                            |
  48. |   How did you hear about KWQ Mail/2?:    _____________________________     |
  49. |                                                                            |
  50. |   ____________________________________________________________________     |
  51. |                                                                            |
  52. |   Where did you get a copy of KWQ Mail/2?:    ________________________     |
  53. |                                                                            |
  54. |   ____________________________________________________________________     |
  55. |                                                                            |
  56. |   Do you use a DOS-based reader?   Yes ___   No ___                        |
  57. |                                                                            |
  58. |----------------------------------------------------------------------------|
  59. |   Suggestions:                                                             |
  60. |                                                                            |
  61. |                                                                            |
  62. |                                                                            |
  63. |                                                                            |
  64. |                                                                            |
  65. |                                                                            |
  66. +----------------------------------------------------------------------------+
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