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Text File  |  1993-05-22  |  1KB  |  50 lines
  1.              DiskTrak for Windows 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. Method of payment:
  18.  
  19.  
  20.        ____ check for $37.50 (US) made payable to Peninsula Software 
  21.  
  22.  
  23.        ____ Visa or MasterCard credit card ($37.50 total)
  24.  
  25.            Credit Card type:  ____ Visa    ____ Mastercard
  26.  
  27.            Credit Card Number: ___________________________
  28.  
  29.            Expiration Date: _______________
  30.  
  31.            Signature: _____________________  Date: ______________
  32.          
  33.  
  34.  
  35. Comment: _________________________________________________
  36.  
  37.          _________________________________________________
  38.  
  39.          _________________________________________________
  40.  
  41.  
  42.  
  43. Send to:     Peninsula Software
  44.              28510 Blythewood Drive
  45.              Palos Verdes CA 90274
  46.  
  47.  
  48.  
  49.          -----> Thank you for supporting shareware <-----
  50.