home *** CD-ROM | disk | FTP | other *** search
/ Monster Media 1994 #1 / monster.zip / monster / WIN_UTL2 / ZIPSCN25.ZIP / ORDER.DOC < prev    next >
Text File  |  1994-01-13  |  1KB  |  28 lines
  1. ==============================[ ORDER FORM ]==================================
  2. Disk And Desk Software                CompuServe ID: Rosanne White 71524, 2416
  3. C/O Richard Ratayczak                 Exec-PC    ID: Richard Ratayczak
  4. ==============================================================================
  5.  
  6. Disk size:  [ ] 3.5" High Density
  7.             [ ] 3.5" Low Density
  8.             [ ] 5.25" High Density
  9.  
  10.  
  11.         Name: _______________________________________________________________
  12.  
  13.      Address: _______________________________________________________________
  14.  
  15. City, ST Zip: _______________________________________________________________
  16.  
  17.      Country: ____________________  Phone: __________________________________
  18.  
  19. Payment by:  [ ] Check   [ ] Money order    Make 'Em payable to:
  20.                                             Richard Ratayczak
  21. Signature: ________________
  22.  
  23.         Mail This to:
  24.     Richard Ratayczak
  25.     2553A South Howell Avenue
  26.     Milwaukee, WI 53207-1651
  27.  
  28.