home *** CD-ROM | disk | FTP | other *** search
/ Magnum One / Magnum One (Mid-American Digital) (Disc Manufacturing).iso / d7 / jaxhost5.arc / JHORDER.FRM < prev    next >
Text File  |  1990-01-29  |  2KB  |  60 lines

  1.  
  2.                JaxHost v5.0 Communications Software Order Form
  3.  
  4.                                       Order Date:  _____________________
  5.  
  6.         Name:     ______________________________________________________
  7.  
  8.         Company:  ______________________________________________________
  9.  
  10.         Address:  ______________________________________________________
  11.  
  12.                   ______________________________________________________
  13.  
  14.         City:     ______________________________________________________
  15.  
  16.         State:    ________________________  ZIP Code:  _________________
  17.  
  18.         Phone:    ______________________________________________________
  19.  
  20.         Where did you obtain JaxHost? __________________________________
  21.  
  22.         If different from above, specify registrant's name to appear in
  23.         each registered copy of JaxHost.  If multiple copies, but same
  24.         name, the name plus "Copy #1", "Copy #2,", etc., will appear in
  25.         each.   Registrant Name(s):
  26.  
  27.         ________________________________________________________________
  28.  
  29.         ________________________________________________________________
  30.  
  31.         ________________________________________________________________
  32.  
  33.         Registration Fees:
  34.  
  35.         Number of copies      Cost per Copy              Remittance
  36.  
  37.            _________      x      $20.00        =         $__________
  38.  
  39.  
  40.         Diskette, Postage, Handling:
  41.          One diskette                   $5.00            $__________
  42.          (Not applicable if registering copy
  43.                   already in your possession.)
  44.  
  45.  
  46.        Payments must be in US dollars.          TOTAL:   $__________
  47.  
  48.  
  49.  
  50.         Remit to:         J. C. Kilday Associates
  51.                           Central Avenue
  52.                           Peaks Island, ME 04108
  53.  
  54.  
  55.         A registration number for converting each copy of JaxHost to
  56.         a registered version will be mailed to you.  If you wish to
  57.         obtain this number directly from our BBS after allowing time
  58.         for us to receive your payment, call the BBS as indicated at
  59.         the end of JAXHOST.DOC, the documentation file.
  60.