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/ Software Vault: The Gold Collection / Software Vault - The Gold Collection (American Databankers) (1993).ISO / cdr35 / robom10a.zip / ORDER.FRM < prev    next >
Text File  |  1993-05-11  |  2KB  |  57 lines
  1.  
  2.  
  3.                      ================================
  4.                       ROBOMAIL 1.0 REGISTRATION FORM
  5.                      ================================
  6.  
  7.  
  8.                     Remit to:  Parsons Consulting
  9.                                5020 S. Lake Shore Drive
  10.                                Suite 3301
  11.                                Chicago, IL  60615-3249
  12.                                U.S.A.
  13.  
  14.      ------------------------------------------------------------------
  15.      | Item                          | Quantity |  Price |    Total   |
  16.      |-------------------------------|----------|--------|------------|
  17.      | RoboMail version 1.0          | ________ | $35.00 | __________ |
  18.      |                               |          |        |            |
  19.      | RoboMail/Robocomm package     | ________ | $65.00 | __________ |
  20.      |                               |          |        |            |
  21.      | Shipping (Outside U.S. only)  | ________ |  $5.00 | __________ |
  22.      |---------------------------------------------------|------------|
  23.      |                                                   |            |
  24.      |   Total amount enclosed                           | __________ |
  25.      ------------------------------------------------------------------
  26.  
  27.      Check desired disk format:    ( ) 5.25"         ( ) 3.5"         
  28.                   Disk Density:    ( ) Low Required  ( ) High OK
  29.  
  30.      Payment by:  ( ) Check or money order (U.S. funds only)
  31.                   ( ) MasterCard
  32.                   ( ) Visa
  33.                   ( ) PO # ______________
  34.  
  35.      Card #: ____________________________________  Exp. Date: _________
  36.  
  37.  
  38.  Signature of card holder: ____________________________________________
  39.  
  40.  
  41.      Name:     ________________________________________________________
  42.  
  43.      Company:  ________________________________________________________
  44.  
  45.      Address:  ________________________________________________________
  46.  
  47.                ________________________________________________________
  48.  
  49.                ________________________________________________________
  50.  
  51.      Phone:    ________________________________________________________
  52.  
  53.     FLASH:  INSTANT GRATIFICATION REGISTRATION ONLINE AT GROUP ONE BBS!
  54.             Call Group One BBS and register with MasterCard or Visa and
  55.             receive your personalized key file immediately!
  56.                             >>>> 312-752-1258 <<<<
  57.