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Text File  |  1996-12-05  |  4KB  |  59 lines
  1.  
  2.  
  3. +------------------------------------------------------------------+----+
  4. |                   IPro ORDER AND REGISTRATION FORM               |1996|
  5. |                                                                  +----|
  6. | Send Check or Money Order to:  BMB Software                           |
  7. |                                P.O. Box 1071                          |
  8. |                                West Springfield, MA   01090-1071      |
  9. |                                USA                                    |
  10. |                                                                       |
  11. | Phone: (413)746-9478      FAX: (413)746-9523       BBS: (413)731-1155 |
  12. |-------------------------------------------------------------------+---|
  13. |  Please print, type, or use editor to fill out form.              |CIS|
  14. |                                                                   +---|
  15. |  Date: _____________________________________________________________  |
  16. |                                                                       |
  17. |  Name: _____________________________________________________________  |
  18. |                                                                       |
  19. |  Company Name: _____________________________________________________  |
  20. |                                                                       |
  21. |  Address1: _________________________________________________________  |
  22. |                                                                       |
  23. |  Address2: _________________________________________________________  |
  24. |                                                                       |
  25. |  City: ________________________________________  State: ____________  |
  26. |                                                                       |
  27. |  Country: ____________________________  Zip: _______________________  |
  28. |                                                                       |
  29. |  Phone: (______)______-____________  FAX: (______)______-___________  |
  30. |                                                                       |
  31. |  Where was IPro obtained? (optional) _______________________________  |
  32. |                                                                       |
  33. |                                                                       |
  34. |  [ ] 3-1/2" 1.44M disk (default if no box checked)                    |
  35. |                                                                       |
  36. |       or                                                              |
  37. |                                                                       |
  38. |  [ ] 5-1/4" 1.2M disk                                                 |
  39. |                                                                       |
  40. |  Make check payable to:  BMB Software                                 |
  41. |-----------------------------------------------------+-----------------|
  42. |                                                     |                 |
  43. |                    ____ copy X $48.00 Registration  | $               |
  44. |     (Registrants receive registering program PPD.)  |                 |
  45. |-----------------------------------------------------|-----------------|
  46. |                                                     |                 |
  47. |                                              TOTAL  | $               |
  48. |                                                     |                 |
  49. |-----------------------------------------------------|-----------------|
  50. |                                                     |                 |
  51. |           Massachusetts residents add 5% sales tax  | $               |
  52. |                                                     |                 |
  53. |-----------------------------------------------------|-----------------|
  54. |                                                     |                 |
  55. |       (All amounts in U.S. currency.)  GRAND TOTAL  | $               |
  56. |                                                     |                 |
  57. +-----------------------------------------------------+-----------------+
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