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Text File  |  1996-04-19  |  3KB  |  58 lines
  1.                          REGISTRATION/ORDER FORM
  2.  
  3. Send multiple product orders to:               LONG LIFE FLOWERS orders to:
  4.  
  5. ARK ANGLES                                     Creative Visions Software
  6. 24 Alexander Ave                               P O Box 540
  7. Hazelbrook  NSW  2779                          Heathmont  VIC  3135
  8. AUSTRALIA                                      AUSTRALIA
  9. Phone:     (047)588100                         Phone:     (03)7203809
  10.   or Intl+61-47-588100                           or Intl+61-3-7203809
  11. Fax:       (047)588638                         Fax:       (03)7203677
  12.   or Intl+61-47-588638                           or Intl+61-3-7203677
  13. Internet:   100237.141@compuserve.com
  14. CompuServe: 100237,141
  15.  
  16. From: Name    ___________________________________________________________
  17.  
  18.       Company ___________________________________________________________
  19.  
  20.       Address ___________________________________________________________
  21.  
  22.       Town    ____________________________  State ________  Code ________
  23.  
  24.       Country ___________________________________________________________
  25.  
  26.       Phone   ____________________________  Fax _________________________
  27.  
  28. Where did you obtain or hear about the software? ________________________
  29.  
  30. Computer:      [ ] XT     [ ] AT/286     [ ] 386     [ ] 486     [ ] >486
  31. Memory Size: ____________    Hard Disk Size: __________
  32. Drives:  [ ] 360K 5.25"   [ ] 720K 3.5"   [ ] 1.2M 5.25"   [ ] 1.44M 3.5"
  33. Screen:    [ ] Mono/Herc     [ ] CGA     [ ] EGA     [ ] VGA     [ ] >VGA
  34. Dos Version# _______    Windows Version# _______    OS/2 Version# _______
  35.  ___________________________________________________ _______ ___________
  36. | P R O D U C T  /  L I C E N S E                   | Q T Y | P R I C E |
  37. |___________________________________________________|_______|___________|
  38. |                                                   |       |           |
  39. |___________________________________________________|_______|___________|
  40. |                                                   |       |           |
  41. |___________________________________________________|_______|___________|
  42. |                                                   |       |           |
  43. |___________________________________________________|_______|___________|
  44. |                                                   |       |           |
  45. |___________________________________________________|_______|___________|
  46. | T O T A L                                                 |           |
  47. |___________________________________________________________|___________|
  48.  
  49. [ ] Bankcard    [ ] Mastercard    [ ] Visa    [ ] Cash/Cheque/Draft/Order
  50.  
  51. Credit Card No  _______ _______ _______ _______   Expiry Date ____ / ____
  52.  
  53. Cardholder Name _________________________________________________________
  54.  
  55. Signature       _______________________________   Date __________________
  56.  
  57. Comments:
  58.