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Text File  |  1995-03-27  |  2KB  |  58 lines
  1.  
  2.                 Order Form For My Personal Diary for Kids V1.0
  3.                 ______________________________________________
  4.                 (USE THIS FORM ONLY TO ORDER FROM ME DIRECTLY)
  5.  
  6. Send To:                                 From: (PLEASE PRINT CLEARLY) 
  7. Chris Maresco                            
  8. 105 Bayview Ave.                         ___________________________________
  9. E. Patchogue NY 11772
  10.                                          ___________________________________
  11. (Please write for bulk
  12. discounts and site licenses.)            ___________________________________
  13.  
  14.                                   Phone: ______________________
  15.  
  16.                          Online Address: ______________________
  17.  
  18. Where did you get this program:
  19.                                          Number Of Copies: _________
  20.  COMPUSERVE ___
  21.         AOL ___                                            X $19.95
  22.     PRODIGY ___                          
  23.       OTHER _________________        OUTSIDE US & CANADA ADD $5.00 S&H  
  24.                                          
  25.                                          Send This Amount: _________
  26.                                          (Checks MUST be in US funds) 
  27.  
  28. I prefer 5 1/4" ____  3 1/2" ____ Disks.  High Density? YES ____  NO ____
  29.  
  30. Would you like to receive a mailer? YES ____  NO ____
  31.  
  32. Orders will be shipped promptly, THANK YOU FOR REGISTERING!
  33. ____________________________________________________________________________
  34.  
  35. Optional questions to help us better understand your needs
  36.  
  37. Computer: _______________   Printer: _______________
  38.  
  39. I use my computer for: ENTERTAINMENT  ____  BUSINESS ____ PROGRAMMING ____
  40.  
  41.                        RECORD KEEPING ____  OTHER ________________________
  42.  
  43. Do you regularly try shareware programs? YES ____ NO ____
  44.  
  45. Suggestions, Comments or Whatever:
  46. (ANY feedback is greatly appreciated, good or bad.)
  47.  
  48. ____________________________________________________________________________
  49.  
  50. ____________________________________________________________________________
  51.  
  52. ____________________________________________________________________________
  53.  
  54. ____________________________________________________________________________
  55.  
  56. ____________________________________________________________________________
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