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Text File  |  1992-12-12  |  2KB  |  61 lines
  1.              DiskTrak for DOS Order Form
  2.              ===========================
  3.  
  4.    Name: _______________________________________________
  5.  
  6. Company: _______________________________________________
  7.  
  8. Address: _______________________________________________
  9.  
  10.          _______________________________________________  
  11.  
  12.    City: _______________________________   State: ______   
  13.  
  14. Country: ______________    ZIP/Postal Code: ____________
  15.  
  16.  
  17.  
  18. Please send me either: ____ one 720K 3.5" diskette
  19.  
  20.                    or: ____ two 360K 5.25" diskettes
  21.  
  22.  
  23.  
  24. Method of payment:
  25.  
  26.  
  27.        ____ check for $25.00 (US) made payable to Peninsula Software 
  28.  
  29.  
  30.        ____ Visa or MasterCard credit card  ($27.50 total)
  31.  
  32.             Note: Visa/MasaterCard orders are acceptable, but Peninsula
  33.                   Software must charge a bank processing fee of $2.50
  34.                   for all credit card orders.
  35.  
  36.            Credit Card type:  ____ Visa    ____ Mastercard
  37.  
  38.            Credit Card Number: ___________________________
  39.  
  40.            Expiration Date: _______________
  41.  
  42.            Signature: _____________________  Date: ______________
  43.          
  44.  
  45.  
  46. Comment: _________________________________________________
  47.  
  48.          _________________________________________________
  49.  
  50.          _________________________________________________
  51.  
  52.  
  53.  
  54. Send to:    Peninsula Software
  55.             28510 Blythewood Drive
  56.             Palos Verdes CA 90274
  57.  
  58.  
  59.  
  60.          -----> Thank you for supporting shareware <-----
  61.