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Text File  |  1994-09-15  |  3KB  |  60 lines
  1.                E Z P N O   O R D E R   F O R M
  2.  
  3.                               Date:___________
  4. Kula Software Inc.
  5. 6070 Marine Drive
  6. West Vancouver BC Canada  V7W 2S3   
  7. tel: (604)921-5974  fax: (604)921-5973
  8. CompuServe 72764,2254
  9.  
  10.                 CUSTOMER INFORMATION
  11.  
  12. Name              _____________________________________________
  13. Address 1         _____________________________________________
  14. Address 2         _____________________________________________
  15. Address 3         _____________________________________________
  16. Postal Code/ZIP   _____________________________________________
  17. Telephone         day:__________________ eve:__________________
  18. Fax               _____________________________________________
  19.           
  20.  
  21.                 ORDER INFORMATION
  22.  
  23. Software obtained from _______________________   version_______
  24. Registration Code      ________________________________________
  25.  
  26. Payment:  Visa  Cheque  Money Order           Diskette:  3 1/2    5 1/4       
  27.  
  28. Visa only: 
  29. Credit card no.______________________________ Exp. date MM:____YY:____
  30. Signature      ______________________________
  31.  
  32. -Credit $5.00 towards the regular registration price if you purchased this
  33.  software directly from a shareware vendor 
  34. -Discount 15% off the regular registration price if you are a 
  35.  senior (over 60), student, or music teacher 
  36. =========================================================================
  37. |Description                  |  Qty  |   Price    |  Extension         |
  38. |===========                  |  ===  |   =====    |  =========         |
  39. |EZPNO software license       |       |   39.95 US |                    |
  40. |                                                  |                    |
  41. |     $5.00 shareware credit applied     ( Y / N ) |                    |
  42. |     15% discount taken                 ( Y / N ) |                    |
  43. |                                                  |                    |
  44. |In USA and Canada add $2.00 shipping and handling |                    |
  45. |Other countries add $5.00 shipping and handling   |                    |                            
  46. |Canadian residents add 7% GST                     |                    |
  47. |B.C. residents add 7% PST                         |                    |      
  48. |                                                  |Total =>            |
  49. =========================================================================
  50.                  
  51.                 CUSTOMER PROFILE
  52.  
  53. Sex                M    F                Age_____
  54. Music Background  _____________________________________________________
  55. CPU type          _____________________ Sound Card_____________________
  56.  
  57.                   FEEDBACK
  58.     _______________________________________________________________
  59.     _______________________________________________________________
  60.     _______________________________________________________________