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Text File  |  1992-04-29  |  2KB  |  76 lines
  1.                              REGISTERATION FORM
  2.  
  3.                                   QMONITOR    
  4.  
  5.  
  6.  Name: ______________________________________________
  7.  
  8.  Company: ___________________________________________
  9.  
  10.  Address: ___________________________________________
  11.  
  12.  City: ______________________________ State: ________
  13.  
  14.  Zip code: _____________________
  15.  
  16.  Phone: _____________________________  Ext: _________
  17.  
  18.  
  19.  
  20.  Product                          Quanity          Price/each       Total
  21. ------------------------------------------------------------------------------
  22.  
  23.  QMONITOR  (Server license)       _______      x       $75     =    _________  
  24.  
  25.  QSELECT   (Server license)       _______      x       $150    =    _________  
  26.  
  27.  MLOGOUT Server version
  28.  WMLOGOUT Server Version          _______      x       $195    =    _________
  29.  
  30.  MLOGOUT/WMLOGOUT
  31.  Special Offer for CIS users      _______      x       $150    =    _________
  32.  
  33.                                     
  34.  
  35.  
  36.                                         ---------------------------------------
  37.  
  38.                         Shipping and Handling:     3.00/per item:   _________
  39.  
  40.  
  41.                                          Tax (VA residents add %4): _________
  42.  
  43.  
  44.                                          Total order:               _________
  45.  
  46. How do you wish to pay for your order:
  47.  
  48.        Purchase Order _______        Check _________        COD _____________
  49.  
  50.        Visa __________   Account Number:  ___________________________________
  51.        Mastercard_____   Expiration Date: _________________
  52.  
  53.  
  54.  
  55. Please specify disk size:      5-1/4___________      3-1/2___________
  56.  
  57.  
  58. Additional information:
  59.  
  60.         How did you learn of QMONITOR? ______________________
  61.  
  62.         What version Netware are you running? ______________
  63.  
  64.         Do you use Windows?                Yes           No
  65.  
  66.  
  67. Please return form to:
  68.  
  69.         Dana Consultants
  70.         PO Box 2953
  71.         Reston, VA 22091
  72.  
  73.         (703) 620-3554
  74.  
  75.  
  76.