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The Disc (Australian) 4
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SUBS.TXT
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1995-01-01
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1KB
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29 lines
SUBSCRIPTIONS
Please send me:
1 x 12 months subscription @ $150 = $ ____
1 x 6 months subscription @ $80 = $ ____
___ x ___ back issue # @ $14.95 ea = $ ____
Total ____
Name:_____________________________________________
(credit card payments - list name as appears on card)
Address: ___________________________________________
________________________________Postcode:___________
(Credit card payments - list home address, not business or PO box)
Phone: (BH)_________________ (AH)___________________
Email:______________________________________________
Please charge my (tick) ____Mastercard ____Visa ____Bankcard
Credit card number: __ __ __ __ __ __ __ __ __ __ __ __ __ __ __ __
Card valid from: ___ /___ to ___ /___
Signature:______________________
Please make cheques payable to: Robot Madness Pty Ltd
Send payment and this form to:
THE DISC SUBSCRIPTIONS
ROBOT MADNESS
LEVEL 2, 11-17 DORCAS STREET
SOUTH MELBOURNE VIC 3205
Fax: 03/ 9690 8337