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Text File  |  1989-03-03  |  4.6 KB  |  60 lines
  1. +=============================================================================+
  2. |             Registration (order) and comment form for Max-Menu              |
  3. |-----------------------------------------------------------------------------|
  4. |                                                                             |
  5. | Name:        Last: _______________________ First: ______________ Middle: __ |
  6. |                                                                             |
  7. | Company:     ________________________________(only if purchased by company) |
  8. |                                                                             |
  9. | Address:     ______________________________________________________________ |
  10. |                                                                             |
  11. |              ______________________________________________________________ |
  12. |                                                                             |
  13. |              ______________________________________________________________ |
  14. |                                                                             |
  15. | Phone:       (______)______-_________  Registration number: _______________ |
  16. |                                                                             |
  17. | Computer:    ______________________________________________________________ |
  18. +=============================================================================+
  19. |                          Registration information:                          |
  20. |----------------------------------------+------------------------------------|
  21. | Check type of order:                   |      Base price per copy:      $30 |
  22. | __ New registration                    |                                    |
  23. | __ Registering additional copies       |    Less discount (below): - $_____ |
  24. | __ Request for site license            |                                    |
  25. |                                        |                Sub-total:   $_____ |
  26. | Check type of disk:                    |                                    |
  27. | __ 5 1/4"     __ 3 1/2"                |   Add $5 if outside U.S.: + $_____ |
  28. |                                        |                                    |
  29. | Number of copies ordered:    _________ | Add $1.50 if 3 1/2" disk: + $_____ |
  30. |                                        |                                    |
  31. | Times your price (right): X $_________ |       Your price (total):   $_____ |
  32. |                                        +------------------------------------|
  33. |        Total to be payed:   $_________ | Discount per copy ordered:         |
  34. |                                        |   0-  9 copies ordered = $0        |
  35. | Check should be payed to the order of  |  10- 99 copies ordered = $1.50     |
  36. | Don Cappaert, for the amount in "Total | 100-199 copies ordered = $3.00     |
  37. | to be payed" (U.S. dollars).           | 200+    copies ordered = $4.50     |
  38. +=============================================================================+
  39. |                 Comments (if more room is needed, use back)                 |
  40. |-----------------------------------------------------------------------------|
  41. |                                                                             |
  42. | ___________________________________________________________________________ |
  43. |                                                                             |
  44. | ___________________________________________________________________________ |
  45. |                                                                             |
  46. | ___________________________________________________________________________ |
  47. |                                                                             |
  48. | ___________________________________________________________________________ |
  49. |                                                                             |
  50. | ___________________________________________________________________________ |
  51. |                                                                             |
  52. | ___________________________________________________________________________ |
  53. |                                                                             |
  54. +=============================================================================+
  55.                                                                                
  56.   Send form (and check) to: Don Cappaert                                       
  57.                             P.O. Box 249                                       
  58.                             Andalusia, IL 61232-0249                           
  59.  
  60.