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Text File  |  1992-07-28  |  4KB  |  55 lines
  1.  
  2.  
  3.  
  4.                                ORDER FORM
  5.  
  6. +-------------------------------------------------------------------------+
  7. |                                                                         |
  8. |           PLEASE USE THIS FORM FOR REGISTRATION OF PBREAK               |
  9. |                                                                         |
  10. |                                                                         |
  11. |                                                                         |
  12. |   SINGLE USER REGISTRATION         $5 (U.S.) x  ______ =  ___________   |
  13. |                                                                         |
  14. |   CURRENT VERSION + PROGRAM                                             |
  15. |   DISK (3.5" OR 5.25" U.S. ONLY)   $8 (U.S.) x  ______ =  ___________   |
  16. |   SPECIFY DISK SIZE _________                                           |
  17. |                                                                         |
  18. |   SINGLE USER REGISTRATION +                                            |
  19. |   NEXT VERSION MAILED TO U.S.                                           |
  20. |   ADDRESS                                                               |
  21. |   SPECIFY DISK SIZE _________     $10 (U.S.) x  ______ =  ___________   |
  22. |                                                                         |
  23. |                                                                         |
  24. |                                                                         |
  25. +-------------------------------------------------------------------------+
  26. |                                                                         |
  27. |   NAME:       _______________________________________________________   |
  28. |                                                                         |
  29. |                                                                         |
  30. |   ADDRESS:    _______________________________________________________   |
  31. |                                                                         |
  32. |                                                                         |
  33. |               _______________________________________________________   |
  34. |                                                                         |
  35. |                                                                         |
  36. |   CITY:       ____________________________ ST:  _____  ZIP:  ________   |
  37. |                                                                         |
  38. |                                                                         |
  39. |                                                                         |
  40. |   PC CLASS:  PC/XT ___ 286 ___ 386 ___ 486 ___ 586 ___ OTHER ________   |
  41. |                                                                         |
  42. |   DOS Version _____________________  PC MAKER _______________________   |
  43. |                                                                         |
  44. |   Do you need a receipt other than your cancelled check?  ___________   |
  45. |                                                                         |
  46. +-------------------------------------------------------------------------+
  47. |      Send check or money order to:  Dickson Computing, Ltd.             |
  48. |                                     411 Gravois Drive                   |
  49. |                                     Shreveport, LA  71106               |
  50. |                                                                         |
  51. |                                                                         |
  52. |                                                                         |
  53. +-------------------------------------------------------------------------+
  54. PBREAK 2.0 (07-28-1992)  69886967458067 666683
  55.