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Text File  |  1992-01-24  |  1KB  |  58 lines
  1.  
  2.  
  3.  
  4.             AC -The Archive Converter-
  5.                Donald M. Langhorne
  6.             South 5241 Columbia Avenue      
  7.                 Hamburg, NY 14075
  8.                   V2.10    
  9.                 Registration Form
  10.                 -----------------   
  11.  
  12.  
  13.     Name:________________________________________________
  14.     
  15.     
  16.     
  17.     Company:_____________________________________________
  18.  
  19.     
  20.     
  21.     Address:_____________________________________________
  22.  
  23.  
  24.     
  25.     Address:_____________________________________________
  26.         
  27.  
  28.     
  29.     City:__________________________  State:____  Zip:__________-______
  30.  
  31.  
  32.     Comments:_________________________________________________________
  33.  
  34.     __________________________________________________________________
  35.     
  36.     __________________________________________________________________
  37.         
  38.         __________________________________________________________________
  39.  
  40.  
  41.  
  42.         Quantity        Price/Per       Total Quantity     Total Price
  43.         --------------------------------------------------------------
  44.        
  45.            1-10             $10            _________  x10   __________
  46.  
  47.  
  48.            11-50            $8             _________  x8    __________
  49.  
  50.  
  51.            51-100           $6             _________  x6    __________
  52.  
  53.  
  54.            100+             $4             _________  x4    __________
  55.  
  56.     <Overseas Orders please Add $1 per license. >
  57.                             
  58.