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/ Monster Media 1996 #14 / Monster Media No. 14 (April 1996) (Monster Media, Inc.).ISO / personal / grocer42.zip / ORDER.FRM < prev    next >
Text File  |  1996-01-24  |  873b  |  27 lines
  1.          Invoice Code: JSFY
  2.  
  3.          Please add me as a supporter of THE GROCER, version 4.2:
  4.  
  5.  
  6.     Name    ______________________________________________________________
  7.  
  8.     Company ______________________________________________________________
  9.  
  10.     Address ______________________________________________________________
  11.  
  12.             ______________________________________________________________
  13.  
  14.     City    ________________________________State _______ Zip ____________
  15.  
  16.  
  17.     Amount  $25.00_x____copies_=_________________   Date   _______________
  18.  
  19.  
  20.    
  21.                                                       Please Mail To:
  22.  
  23.                                                       Richard Zakas
  24.                                                       7137 Plough Drive
  25.                                                       Charlotte, NC  28227
  26.  
  27.