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/ Intermedia 1998 January / inter1_98.iso / internet / tray11 / order.tx_ / order.tx
Text File  |  1997-06-24  |  2KB  |  52 lines
  1. *** Shareware Order Form ***
  2.  
  3. Program Name:    _________________________________________________
  4.  
  5. # of copies:    _________________________________________________
  6.  
  7.          X    $9.95    (Single user price)
  8.  
  9. Total:        $________________________________________________
  10.  
  11.  
  12. * Make Check Or Money Order Payable To *        
  13.  
  14. Future Business Solutions
  15. Shareware Division
  16. P.O Box 563
  17. Arlington, VA 22216
  18.  
  19.  
  20. * Source Program Was Downloaded From *
  21.  
  22. Compuserve:    __
  23. AOL:        __
  24. Prodigy:    __
  25. BBS:        __
  26. Web:        __
  27. Vendor:        _________________________________________________
  28. Other:        _________________________________________________
  29.  
  30.  
  31. * Ship To *
  32.  
  33. Name:        _________________________________________________
  34. Address1:    _________________________________________________
  35. Address2:    _________________________________________________
  36. City:        _________________________________________________
  37. State:        _________________________________________________
  38. Zip:        _________________________________________________
  39. Company:    _________________________________________________
  40. Phone:        _________________________________________________
  41. Email:        _________________________________________________
  42.  
  43.  
  44. * Additional Comments, Suggestions, Bug Reports *     
  45.         _________________________________________________
  46.         _________________________________________________
  47.         _________________________________________________
  48.         _________________________________________________
  49.         _________________________________________________
  50.         _________________________________________________
  51.         _________________________________________________
  52.         _________________________________________________