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Text File  |  1996-02-11  |  4KB  |  100 lines
  1. ________________________________________________________________________________
  2.  
  3.                              W e b W r i t e r / 2
  4.                              =====================
  5.  
  6.                                   Version 1.1
  7.  
  8.                                REGISTRATION FORM                           
  9.  
  10.  
  11. --------------------------------------------------------------------------------
  12.  
  13.  
  14.  
  15.                   Mail Orders To: BMT Micro
  16.                                   452 Horn Road
  17.                                   Wilmington, NC 28412-2411
  18.                                   U.S.A.
  19.  
  20.                     Voice Orders: 9:00am - 7:00pm EST (-5 GMT)
  21.                                   (800  414-4268 (orders only)
  22.                                   (910) 791-7052
  23.  
  24.                       Fax Orders: (910) 350-2937  24 hours / 7 Days
  25.                                   (800) 346-1OS2 (1672) In the US and Canada
  26.  
  27.               Telnet: bmt.wilmington.net
  28.  
  29.          Online Orders via modem: (910) 350-8061  10 lines, all 14.4K
  30.                                   (910) 799-0923  Direct 28.8K line
  31.  
  32. Ordering and general ordering questions:
  33.                                 Via AOL: bmtmicro
  34.                          via Compuserve: Thomas Bradford, 74031,307
  35.                            via Internet: thomas.bradford@bmtmicro.com
  36.  
  37.      We accept Visa, Mastercard, Discover, American Express, Money Order,
  38.      Cashiers Check, Personal Check.  Please do not send cash in the mail.
  39.      Personal checks are subject to clearance.
  40.  
  41.      Checks and money orders should be made payable to BMT Micro.
  42.  
  43.  
  44. ________________________________________________________________________________
  45.  
  46.                              W e b W r i t e r / 2
  47.                              =====================
  48.  
  49.                                   Version 1.1
  50.  
  51.                                REGISTRATION FORM                           
  52.  
  53.  
  54. --------------------------------------------------------------------------------
  55.  
  56.  
  57.    First Name: ___________________  MI: ____ Last Name: ________________________
  58.  
  59.       Address: _________________________________________________________________
  60.  
  61.                _________________________________________________________________
  62.  
  63.                _________________________________________________________________
  64.  
  65.                _________________________________________________________________
  66.  
  67.       Country: ___________________
  68.  
  69.     Telephone: ___________________  Home [ ]  Work [ ]
  70.       
  71.                ___________________  Home [ ]  Work [ ]
  72.  
  73. Email Address: _________________________________________
  74.  
  75.  
  76.  
  77. --------------------------------------------------------------------------------
  78.  
  79.      Product                    Quantity Price  Number of copies
  80.      _________________________  ______________  ________________
  81.  
  82.                                               x ____________ = + $_______
  83.  
  84.                                               x ____________ = + $_______
  85.  
  86.                                               x ____________ = + $_______
  87.  
  88.      Total:                                                      $_______
  89.  
  90.     
  91. For credit card payment only                                   
  92.  
  93.         Circle one: VISA / Master / Discover / American Express
  94.  
  95.         Credit card number:_____________________________________________ 
  96.         
  97.         Expiration date:________________________________________________ 
  98.  
  99.         Authorization signature:________________________________________ 
  100.