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Text File  |  1996-04-19  |  1KB  |  47 lines
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  7.                       FastLst Credit Card Registration Form
  8.                       PSL Part number 11471
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  10.                   *****************************************
  11.                   * DO NOT SEND this form to the author ! *
  12.                   *****************************************
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  14.         Please read carefully Register.Doc for instructions.
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  17.                                           Date _________________________
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  20.   Cardholder's name, exactly as it appears on the credit card:
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  22.              ___________________________________________________________
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  24.   [Company:] ___________________________________________________________
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  27.   Billing address for the card:
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  29.              ___________________________________________________________
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  31.              ___________________________________________________________
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  33.              ___________________________________________________________
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  35.     Payment by:   ( ) MasterCard          ( ) Visa
  36.                   ( ) American Express    ( ) Discover Card
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  38.     Card #:  ________________________________  Exp. Date:  _____________
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  40.     Signature of cardholder: ___________________________________________
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