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Text File  |  1992-10-09  |  4KB  |  56 lines
  1.   ┌───────────────────────────────────────────────────────────────────┐
  2.   │                    ╔═══════════════════════╗                      │
  3.   │                    ║  REGISTRIER-Formular  ║                      │
  4.   │                    ╚═══════════════════════╝                      │
  5.   │                                                                   │
  6.   │  Sie möchten sich für dieses SUPER-Programm registrieren lassen?  │
  7.   │  Kein Problem ! Senden Sie einfach dieses Formular an unten-      │
  8.   │  stehende Adresse.                                                │
  9.   │                                                                   │
  10.   │  Programm-Name     JILL OF THE JUNGLE    Datum:________           │
  11.   │                                                                   │
  12.   │  Name_________________________________________________            │
  13.   │                                                                   │
  14.   │  Vorname______________________________________________            │
  15.   │                                                                   │
  16.   │  Straße_______________________________________________            │
  17.   │                                                                   │
  18.   │  Plz___________ Ort___________________________________            │
  19.   │                                                                   │
  20.   │                                                                   │
  21.   │  Unterschrift:________________________________________            │
  22.   │                                                                   │
  23.   │      ┌─────────────────────────────────────────────────────┐      │
  24.   │      │  [ ]  JILL OF THE JUNGLE                   59,- DM  │      │
  25.   │      └─────────────────────────────────────────────────────┘      │
  26.   │                                                                   │
  27.   │  Bitte einsenden an:                                              │
  28.   │                                                                   │
  29.   │         ┌───────────────────────────────────────────┐             │
  30.   │         │  CDV               │                      │             │
  31.   │         │  Wolfgang Gäbler   │  Tel. 0721-2 22 95   │             │
  32.   │         │  Ettlingerstr. 5   │  Fax. 0721-2 13 14   │             │
  33.   │         │                    │                      │             │
  34.   │         │  7500 Karlsruhe    │  BTX  *CDV#          │             │
  35.   │         └───────────────────────────────────────────┘             │
  36.   │                                                                   │
  37.   │  Belieferung  per ( ) EUROCARD  ( ) AMERICAN EXPRESS  ( ) VISA    │
  38.   │                                                                   │
  39.   │             Karten-Nummer:_____________________________           │
  40.   │                                                                   │
  41.   │             Ablauf-Datum:______________________________           │
  42.   │                                                                   │
  43.   │             Karteninhaber:_____________________________           │
  44.   │                                                                   │
  45.   │             per ( ) Nachnahme   ( ) Vorkasse (Scheck oder Bar)    │
  46.   │                                                                   │
  47.   │                                                                   │
  48.   │ NUR bei Großfirmen/Institutionen (Angabe eines Ansprechpartners!) │
  49.   │                                                                   │
  50.   │            per ( ) Rechnung    Ansprechp.:______________________  │
  51.   │                                                                   │
  52.   │                                Abteilung:_______________________  │
  53.   │                                                                   │
  54.   │       Alle Preise freibleibend. Zuzüglich Porto/Verp. 10,- DM     │
  55.   └───────────────────────────────────────────────────────────────────┘
  56.