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Text File  |  1996-05-05  |  2KB  |  60 lines
  1.                        RJCRUSH ORDER FORM
  2.                     (Current version: v1.10)
  3.  
  4. Name: _________________________________________________________
  5.  
  6.  
  7. Address: ______________________________________________________
  8.  
  9.  
  10.          ______________________________________________________
  11.  
  12.  
  13.          ______________________________________________________
  14.  
  15.  
  16.          ______________________________________________________
  17.  
  18.  
  19. Email Address (if any): _______________________________________
  20.  
  21.  
  22. Signature: ____________________________________________________
  23.  
  24.  
  25. Telephone (optional): _________________________________________
  26.  
  27.  
  28. FAX (optional): _______________________________________________
  29.  
  30.  
  31. Form of payment: CHEQUE __ POSTAL ORDER __ OTHER ______________
  32.  
  33.  
  34. Payment inside South Africa: __________ x R40 = _______________
  35.  
  36.        including source-code __________ x R20 = _______________
  37.  
  38.             including manual __________ x R10 = _______________
  39.  
  40.                                         Total = _______________
  41.  
  42. Payment outside South Africa: _________ x $20 (US) = __________
  43.  
  44.        including source-code __________ x $10 (US) = __________
  45.  
  46.             including manual __________ x $5 (US)  = __________
  47.  
  48.                                              Total = __________
  49.  
  50.  
  51. Media required (mark with X): ___________ 5.25" __________ 3.5"
  52.  
  53.  
  54. Address to send to:    Roland Skinner
  55.                        RJS Software
  56.                        P.O. Box 14134
  57.                        Bredell
  58.                        1623
  59.                        Republic of South Africa
  60.