home *** CD-ROM | disk | FTP | other *** search
/ The Best of Select: Games 4 / CD_1.iso / games / silcity / order.frm < prev    next >
Text File  |  1993-01-16  |  3KB  |  65 lines
  1.  
  2.  
  3.           SILICON CITY                     ORDER FORM: A001
  4.                                                          
  5.           
  6.           Mail orders to: Lyric Software Company
  7.                           25 Woody Lane
  8.                           Northport, NY 11768
  9.           
  10.           Phone orders to: (516) 754-5570
  11.           
  12.           --------------------------------------------------
  13.           | Description                |  Price  |  Total  |
  14.           --------------------------------------------------
  15.           | SILICON CITY               |  $19.00 |  $19.00 |
  16.           | Sales Tax (NY Residents)   |    1.62 |         |
  17.           | Extra shipping outside USA |    3.00 |         |
  18.           | Shipping and handling      |    3.00 |    3.00 |
  19.           --------------------------------------------------
  20.                           TOTAL AMOUNT ENCLOSED: |         |
  21.                                                  -----------
  22.           
  23.           Make checks payable to Lyric Software Company.
  24.           Checks must be drawn on a US bank.  If ordering
  25.           outside the US, please use a credit card, or a
  26.           postal money order in US Funds.
  27.           
  28.           Disk Size:  ___ 3.5"   ___ 5.25"
  29.           [ ] Check   [ ] VISA   [ ] Master Card
  30.           
  31.           Card Number: _________________________________
  32.           
  33.           Expiration Date: _____________________________
  34.           
  35.           Signature: ___________________________________
  36.  
  37.           
  38.           Name: ________________________________________
  39.           
  40.           Address: _____________________________________
  41.           
  42.           City: ________________________________________
  43.           
  44.           State/Country: _______________________________
  45.           
  46.           Zip/Postal Code: _____________________________
  47.           
  48.           I received the SILICON CITY DEMO from:
  49.           [ ] friend      [ ] disk vendor  [ ] user group
  50.           [ ] free BBS    [ ] pay BBS      [ ] other
  51.           
  52.           If you downloaded the demo from your local BBS,
  53.           we'd like to make a $5.00 contribution to that
  54.           BBS.  Please enter the BBS's name and phone 
  55.           number, including area code:
  56.  
  57.           Name:_________________________________________ 
  58.           
  59.           Phone: (______)______________________________
  60.           
  61.           Comments, suggestions:________________________
  62.           
  63.           ______________________________________________
  64.  
  65.