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/ Monster Media 1996 #15 / Monster Media Number 15 (Monster Media)(July 1996).ISO / internet / edgar2w.zip / ORDER.DOC (.txt) < prev    next >
Word Document  |  1996-01-08  |  11KB  |  46 lines
  1.  
  2. Edgar to Word Wizard Registration Form
  3.  
  4. |                |                                          |
  5. |Name:           |                                          |
  6. |                |                                          |
  7. |Company:        |                                          |
  8. |                |                                          |
  9. |Address:        |                                          |
  10. |                |                                          |
  11. |Ct, State, Zip  |                                          |
  12. |                |                                          |
  13. |Email:          |                                          |
  14. |                |                                          |
  15. |Payment Method: |                                          |
  16. |                |Visa ____     Mcard ____    Amex ____  Chk|
  17. |                |_____                                     |
  18. |                |                                          |
  19. |Card / Check #: |                                          |
  20. |                |                                          |
  21. |Expiration Date:|                                          |
  22. |                |                                          |
  23. |                |# Copies ________    *  $19.50 = ________ |
  24. |                |                                          |
  25. |                |$5.00 discount if before June 30, 1996    |
  26. |                |                                          |
  27. |                |I agree to pay above total according to   |
  28. |                |card issuer agreement.                    |
  29. |                |                                          |
  30. |Signed:         |                                          |
  31.  
  32. Please send to:
  33.  
  34. Internet - nextgensft@aol.com
  35. CompuServe - 72154,1174
  36. AOL nextgensft
  37.  
  38. Fax 703-560-1266
  39.  
  40. Next Generation Software, Inc.
  41. 2831 Gallows Rd. Suite 201
  42. Fall Church, VA 22042
  43.  
  44. Thank you for registering the Edgar to Word Wizard
  45.  
  46.