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Text File  |  1993-08-29  |  966b  |  41 lines
  1.                RoadKill Software Registration Form
  2.         ------------------------------------------------
  3.  
  4. Date:
  5.  
  6.  
  7.  
  8. Name:________________________________________________________________________
  9.  
  10. Address:_____________________________________________________________________
  11.  
  12. City/State:__________________________________________________________________
  13.  
  14. Postal/ZIP Code:_____________________________________________________________
  15.  
  16. Home Phone # : (___)___-____            Business Phone # : (___)___-____
  17.  
  18. Disk type: check one:      [    ] 3.5"            [    ] 5.25"
  19.  
  20. Disk capacity:    [    ] 1.44 megs      [    ] 1.2 megs     [    ] 720K
  21.  
  22.  
  23.  
  24. Sales Tax included.
  25.  
  26. Make check or money order payable to:
  27.  
  28.          James Zeidel
  29.          26 N. Madison
  30.          La Grange, IL 60525
  31.  
  32.  
  33.  
  34. Amount:               $7.00 postage included
  35.  
  36. Amount Enclosed:       ___________________
  37.  
  38.  
  39. ---------------------------------------------------------------------------
  40. Comments:
  41.