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Text File  |  1996-09-29  |  2KB  |  47 lines
  1.  
  2. =====================================================================
  3.  
  4.                        SysPic 4.00 ORDER FORM
  5.  
  6.                               Send to:
  7.           Grzegorz Calkowski, Rzedowice, ul.Dobrodzienska 8
  8.                       42-780 Dobrodzien, POLAND
  9.           E-mail: unclemat@irc.pl, gcal@matinf.pcz.czest.pl
  10.  
  11. =====================================================================
  12.  
  13.       Name: _______________________________________________________
  14.  
  15.    Address: _______________________________________________________
  16.  
  17.       City: ___________________________ State: ____________________
  18.  
  19.         PC: ___________________________ Country: __________________
  20.  
  21.     E-mail: _______________________________________________________
  22.     
  23.  
  24.           Shareware fee sent:     ( ) US$ 10
  25.                                   ( ) 15 DEM
  26.                                   ( ) 10 PLN (Poland only)
  27.  
  28.           Payment method:         ( ) money included with this mail
  29.                                   ( ) PMO (Postal Money Order)
  30.                                   ( ) Bank transfer
  31.  
  32.           Send me the keyfile:
  33.  
  34.           ( ) via E-mail, no extra costs, OR
  35.  
  36.           ( ) via Snail-mail on DD floppy disk, I add
  37.  
  38.                                   ( ) US$ 5
  39.                                   ( ) 5 DEM
  40.                                   ( ) 3 PLN (Poland only)
  41.  
  42.       I have read the Copyright and Distribution notes and do agree.
  43.  
  44.  
  45.       Date: _____________________     Signature: __________________
  46.  
  47.