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PSL.CRD
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1996-04-19
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47 lines
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FastLst Credit Card Registration Form
PSL Part number 11471
*****************************************
* DO NOT SEND this form to the author ! *
*****************************************
Please read carefully Register.Doc for instructions.
Date _________________________
Cardholder's name, exactly as it appears on the credit card:
___________________________________________________________
[Company:] ___________________________________________________________
Billing address for the card:
___________________________________________________________
___________________________________________________________
___________________________________________________________
Payment by: ( ) MasterCard ( ) Visa
( ) American Express ( ) Discover Card
Card #: ________________________________ Exp. Date: _____________
Signature of cardholder: ___________________________________________
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