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Text File  |  1993-02-16  |  2KB  |  60 lines
  1. HorM v1.00a Order Form
  2. ----------------------
  3.  
  4. Date: __________________
  5.  
  6. Name: ___________________________________________________________________
  7.  
  8. Please print your name clearly as your registration number will be based
  9. on it.
  10.  
  11. Street: _________________________________________________________________
  12.  
  13. City: _________________ State/Province:_______________ Zip: _____________
  14.  
  15. Country:_________________________________________________________________
  16.  
  17.  
  18. Phone#: _________________________________________________________________
  19.  
  20.  
  21. EMail: __________________________________________________________________
  22.  
  23.  
  24. [  ] Please deliver updates via this BBS/Host system!
  25.      ( only 9600bps+ please! )
  26.  
  27.      BBS/Host Name: _____________________________________________________
  28.  
  29.      Number(s): _________________________________________________________
  30.  
  31.      [  ] File attach to message  [  ] Private upload
  32.  
  33.      [  ] Other _________________________________________________________
  34.  
  35.  
  36. Disk format:  [  ] 3.5"   [  ] 5.25"
  37.  
  38.  
  39. Registration -------------------------- $15 x quantity ______ = $________
  40. Please see REGBEN.TXT for a list of registration benefits.
  41.  
  42. Comments: _______________________________________________________________
  43.  
  44. _________________________________________________________________________
  45.  
  46. _________________________________________________________________________
  47.  
  48. _________________________________________________________________________
  49.  
  50.  
  51. Please make out a check or money order to Daniel Otis and
  52. send it along with this completed registration to:
  53.  
  54.   Daniel Otis
  55.   DSI
  56.   1889 Lindo St.
  57.   Benicia, CA  94510-2315
  58.  
  59. 
  60.