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Text File  |  1990-12-03  |  2KB  |  55 lines
  1.                       Program Source Code Manager
  2.  
  3.                            Registration Form
  4.  
  5.         -----------------------------------------------------------
  6.  
  7.   Remit to:    J. Bart Henthorn
  8.                10607 E. Lowry Pl.
  9.                Aurora, CO  80010-4035
  10.                FAX: (303) 341-7336
  11.  
  12.                   ______ copies of PSCM @ $15: _____________
  13.                     (Educational Institutions only)
  14.  
  15.                   ______ copies of PSCM @ $25: _____________
  16.                     (Basic Registration)
  17.  
  18.                   ______ copies of PSCM @ $40: _____________
  19.                     (Includes Printed Docs)
  20.  
  21.         Colorado residents add 3.6% sales tax: _____________
  22.  
  23.                                         Total: _____________
  24.  
  25.         Check:         Check #: __________________
  26.  
  27.         Credit Card:      Visa: ____       Mastercard: ____
  28.  
  29.                         Card #: ________________________________________
  30.  
  31.                      Exp. Date: ____________
  32.  
  33.                      Signature: ________________________________________
  34.  
  35.         (FAX Orders MUST use Credit Card. Sorry, no checks by FAX)
  36.  
  37.  
  38. -------------------------------------------------------------------------------
  39.  
  40.  
  41.               Name: ____________________________________________________
  42.  
  43.       Company name: ____________________________________________________
  44.  
  45.            Address: ____________________________________________________
  46.  
  47.                     ____________________________________________________
  48.  
  49.   City, State, Zip: ____________________________________________________
  50.  
  51.            Country: _______________________________________ (if not USA)
  52.  
  53.          Telephone: ____________________________________________________
  54.  
  55.