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Text File  |  1992-11-01  |  2.2 KB  |  64 lines
  1. ---------------------- DMalloc 1.00 Registration Form -----------------------
  2.  
  3. Enclosed is US$____.___ to register ___ copies of DMalloc 1.0
  4.  
  5.        DMalloc 1.0 at US$ 41.-- per copy.............$_____.___
  6.  
  7.        Additional printed manuals (US$ 11.--/copy)...$_____.___
  8.  
  9.        Add Shipping fee of US$ 6.--..................$_____.___ 
  10.  
  11.                                               TOTAL: $_____.___
  12.  Make checks payable to:   Ben Morris, SpeedSoft Development
  13.                 Send to:   2232 Tashy Place
  14.                            V8N4R6 Victoria BC, Canada
  15.  
  16.  Please charge my VISA credit card accout| Your signature, please:
  17.                                          |
  18.    card number..... ____ ____ ____ ____  |
  19.                                          |
  20.    expiration date. ___ / ___            |
  21.                                          |
  22.    card holder..... ___________________  | _______________________________
  23.  
  24. Name as should appear on DMalloc screen ("registrant name" - 30 char. max):
  25.  
  26.          ______________________________
  27.  
  28. Please ship to:
  29.  
  30. Name:    _____________________________________________________________________
  31.  
  32. Address: _____________________________________________________________________
  33.  
  34.          _____________________________________________________________________
  35.  
  36.          _____________________________________________________________________
  37.  
  38. Phone:  (___)_________ [optional]
  39.  
  40. Fax  :  (___)_________ [optional]
  41.  
  42. Where did you hear about DMalloc?
  43.  
  44.         ______________________________________________________________________
  45.  
  46. Where did you get your Shareware Copy of DMalloc?
  47.  
  48.         Friend____   CompuServe____   GEnie____    Prodigy____   Delphi____
  49.  
  50.         Other BBS (which one?)________________________________________________
  51.  
  52.         Disk Vendor (which company?)__________________________________________
  53.  
  54.         Other_________________________________________________________________
  55.  
  56. Do you have any suggestions for future revisions of DMalloc?
  57.    (use other side, if needed)
  58.  
  59.         ______________________________________________________________________
  60.  
  61.  
  62.  
  63. DISK-BEN 01NOV92                                                            
  64.