home *** CD-ROM | disk | FTP | other *** search
/ 500 Game Surplus / XSurplus.iso / 626 / ORDER.TXT < prev    next >
Text File  |  1994-11-08  |  1KB  |  51 lines

  1. -----------------------------------------------------------
  2. DOUBLE MATCH 1.0   TRIPLE YAHOO! 2.0c   WHEEL OF LUCK 2.1d
  3. -----------------------------------------------------------
  4.  
  5. REGISTRATION FORM
  6.  
  7. Please print and return this form with your payment by check 
  8. for the amount indicated below to:
  9.  
  10.     DAN PURATY
  11.     3536 KENT ROAD
  12.     STOW, OHIO  44224-4602
  13.  
  14. You will receive registered version(s) of the program(s) on 
  15. diskette and a serial number for self-registering all future 
  16. Shareware releases - FREE UPGRADES!
  17.  
  18.  
  19.     Registration Fees:                   Diskette Size:
  20.     ---------------------------          ----------------
  21.     [ ] Double Match   $12.00            [ ] 3-1/2"
  22.  
  23.     [ ] Triple Yahoo!  $10.00            [ ] 5-1/4"
  24.  
  25.     [ ] Wheel of Luck  $10.00
  26.  
  27.          Add Shipping   $2.00  (add only once)
  28.  
  29.        Total Enclosed $_______
  30.  
  31.  
  32.     Name ________________________________________________
  33.  
  34.     Company (if applicable) _____________________________
  35.  
  36.     Address _____________________________________________
  37.  
  38.     City __________________________________ State _______
  39.  
  40.     Zip __________________ Phone ________________________
  41.  
  42.     PC/CPU/Speed ________________________________________
  43.  
  44.     Sound Card?  [ ] No  [ ] Yes : ______________________
  45.  
  46.     Where Obtained? _____________________________________
  47.  
  48.     Suggestions/Comments ________________________________
  49.  
  50.     _____________________________________________________
  51.