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/ The 640 MEG Shareware Studio 2 / The 640 Meg Shareware Studio CD-ROM Volume II (Data Express)(1993).ISO / dbase / ronsstat.zip / ORDER.FRM < prev    next >
Text File  |  1992-09-18  |  4KB  |  88 lines
  1.  
  2.                             ┌─────────────────────┐
  3. ╓───────────────────────────┤ O R D E R   F O R M ├──────────────────────────╖
  4. ║                           └─────────────────────┘                          ║
  5. ║                                                                            ║
  6. ║                 RonsSTAT - File database Overview generator                ║
  7. ║               (C)1991-1992 Ron van Rossum All Rights Reserved              ║
  8. ║                                                                            ║
  9. ║                ┌───────────────────────────────────────────┐               ║
  10. ║                │ Mail to: Ron van Rossum, Adenauerlaan 84, │               ║
  11. ║                │   3137 JA  Vlaardingen, The Netherlands   │               ║
  12. ║                └───────────────────────────────────────────┘               ║
  13. ╙────────────────────────────────────────────────────────────────────────────╜
  14.  
  15.  
  16.             BBS Name as in Makewild : _________________________________
  17.  
  18.           SYSOP NAME as in Makewild : _________________________________
  19.  
  20.             WILDCAT! registration # : __ __ - __ __ __ __
  21.  
  22.  
  23.                 Name : ________________________________________________
  24.  
  25.              Address : ________________________________________________
  26.  
  27.                      : ________________________________________________
  28.  
  29.                      : ________________________________________________
  30.  
  31.                Phone : ________________________________________________
  32.  
  33.            BBS Phone : ________________________________________________
  34.  
  35.  
  36.  
  37.            Signature : ________________________________________________
  38.  
  39.  
  40.  
  41.          Please check desired item:
  42.  
  43.          __ Registration (Download key) ..... DGL 20 / $12 USD  _______
  44.  
  45.          __ Registration (On disk)
  46.             │
  47.             ├──── Inside The Netherlands .... DGL 30 / $18 USD  _______
  48.             │
  49.             └──── Outside The Netherlands ... DGL 35 / $20 USD  _______
  50.  
  51.             Disk format:   3,5"    5,25"   (Please circle one)
  52.  
  53.                                                          TOTAL  _______
  54.  
  55.          (DGL = Dutch Guilders, USD = US Dollars)
  56.  
  57.  
  58.               ┌─────────────────────────────────────────────────┐
  59.               │ Payment (Sorry, no EUROCHEQUES or Creditcards): │
  60.               ├─────────────────────────────────────────────────┤
  61.               │ ( )CASH [ On your own risk! ]                   │
  62.               ├─────────────────────────────────────────────────┤
  63.               │ ( )INTERNATIONAL POSTAL MONEY ORDER             │
  64.               │                                                 │
  65.               │  Make payable to:  A.M. van Rossum              │
  66.               │                    Adenauerlaan 84              │
  67.               │                    3137 JA  Vlaardingen         │
  68.               │                    The Netherlands              │
  69.               ├─────────────────────────────────────────────────┤
  70.               │ ( )GIRO                                         │
  71.               │ ( )GIROBETAALKAART                              │
  72.               │                                                 │
  73.               │  Make payable to:  A.M. van Rossum              │
  74.               │                    Adenauerlaan 84              │
  75.               │                    3137 JA  Vlaardingen         │
  76.               │                    The Netherlands              │
  77.               │  Giro account:     2917882                      │
  78.               ├─────────────────────────────────────────────────┤
  79.               │ ( )BANKTRANSFER                                 │
  80.               │                                                 │
  81.               │  Make payable to:  A.M. van Rossum              │
  82.               │                    Account number 2917882       │
  83.               │  Bank address:     Postbank, Girokantoor Arnhem │
  84.               │                    Postbus 98000                │
  85.               │                    6800 GA  ARNHEM              │
  86.               │                    The Netherlands              │
  87.               └─────────────────────────────────────────────────┘
  88.