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ORDERFRM.DOC
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1996-12-28
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2KB
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51 lines
------------------------------------------------------------------
REGISTRATION FORM
PADHD ver. 2.1
Copyright (c) 1996 by Gary L. Robinson
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CASH, CHECK or MONEY ORDER
--------------------------
Please complete the following information and return this form with your
check or money order to the address below. Please make all checks and
money orders for funds payable to Gary L. Robinson.
Current U.S.A. price is $25.00 for a single copy. Please contact
me for aditional information on multiple registration price listings or
for foreign orders.
Please submit to: Gary L. Robinson
P.O. Box 359
Christiansburg, OH 45389
USA
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<Please Type or Print Clearly>
Name: ___________________________________________________________
Company: ________________________________________________________
Address: ________________________________________________________
________________________________________________________
City: _____________________ St or Prov: ________________________
Postal Code: ________________ Country: _________________________
Date: ___-___-______
I would like to register: Totals
____ Copy(s) of PADHD @ $25.00 per copy: $___________________
OHIO Residents add %6.5 for state sales tax: $___________________
I am including a check or money order for: $___________________
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