home *** CD-ROM | disk | FTP | other *** search
- Grapevine Amiga Internet Relay Chat Client User Registration Form
-
- ***************************************************************************
-
- Mail to: Brian J. Cerveny !! WARNING: This address is not !!
- 36137 North Grand Oaks Court !! guaranteed to be current! !!
- Apt G02 !! Please make sure you have !!
- Gurnee IL 60031 !! the correct address before !!
- USA !! mailing your registration !!
-
-
- Name: __________________________________________________________________
-
-
- Address: __________________________________________________________________
-
-
- City: __________________________________ State/Province: _______________
-
-
- Zip Code: _______________ Country: _________________________________________
-
-
- E-mail: _______________________________________ IRC Nick: ________________
-
- ***************************************************************************
-
- Registration of Grapevine entitles you to free upgrades to all future major
- versions of the program. Updates will be distributed online, or by mail
- for US$5 for the disk and shipping costs.
-
- The cost of registration is $25 in United States currency. Accepted forms
- of payment are U.S. cash currency, bank or postal money order drawn in
- U.S. funds, and certified cheque in U.S. funds.
-
- Personal cheques are accepted on an individual basis with permission of the
- author. Contact the author for prior approval.
-
- ***************************************************************************
-
- ORDER:
- Grapevine Registration: U.S. $25
-
- Payment method (CIRCLE ONE): (1) U.S. currency (2) Money order
-
- (2) Certified cheque (4) Personal cheque
- (with permission)
-
- ***************************************************************************
-
- I agree to all terms outlined in the LICENSE section of the Grapevine user
- manual and to the terms of registration named above.
-
-
- ___________________________________________ _________________________
- Signature Date
-