home *** CD-ROM | disk | FTP | other *** search
/ Windows 95 Top 50 Winners / Top50.iso / KCHESS / ORDERFRM.TXT < prev    next >
Text File  |  1997-04-04  |  2KB  |  49 lines
  1.                    REGISTRATION/ORDER FORM
  2.  
  3. To: ARK ANGLES        Phone: (047)588100 or Intl+61-47-588100
  4.     P O Box 190       Fax:   (047)588638 or Intl+61-47-588638
  5.     Hazelbrook 2779   Internet:     100237.141@compuserve.com
  6.     AUSTRALIA         CompuServe:                  100237,141
  7.  
  8. Name    _____________________________________________________
  9.  
  10. Company _____________________________________________________
  11.  
  12. Address _____________________________________________________
  13.  
  14. Town    ________________________  State _______  Code _______
  15.  
  16. Country _____________________________________________________
  17.  
  18. Phone   __________________________  Fax _____________________
  19.  
  20. E-mail  _____________________________________________________
  21.  
  22. Where software seen or obtained _____________________________
  23.  
  24. Drives:  [ ]5.25 360K  [ ]3.5 720K  [ ]5.25 1.2M  [ ]3.5 1.4M
  25.  
  26. DOS Ver# ________   Windows Ver# ________   OS/2 Ver# _______
  27.  _______________________________________ _______ ___________
  28. | P R O D U C T  /  L I C E N S E       | Q T Y | P R I C E |
  29. |_______________________________________|_______|___________|
  30. |                                       |       |           |
  31. |_______________________________________|_______|___________|
  32. |                                       |       |           |
  33. |_______________________________________|_______|___________|
  34. |                                       |       |           |
  35. |_______________________________________|_______|___________|
  36. |                                       |       |           |
  37. |_______________________________________|_______|___________|
  38. | T O T A L                                     |           |
  39. |_______________________________________________|___________|
  40.  
  41. [ ]AmEx  [ ]Bankcard  [ ]Mastercard  [ ]Visa   [ ]Cash/Cheque
  42.  
  43. Credit Card No  _____ _____ _____ _____   Expiry Date ___/___
  44.  
  45. Cardholder Name _____________________________________________
  46.  
  47. Signature       ___________________________   Date __________
  48.  
  49. Comments: