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/ Monster Media 1996 #15 / Monster Media Number 15 (Monster Media)(July 1996).ISO / prog_gen / kinstw27.zip / ORDERFRM.TXT < prev    next >
Text File  |  1996-06-05  |  2KB  |  50 lines
  1.                    REGISTRATION/ORDER FORM
  2.  
  3. To: ARK ANGLES        Phone: (047)588100 or Intl+61-47-588100
  4.     P O Box 190       Fax:   (047)588638 or Intl+61-47-588638
  5.     Hazelbrook 2779   Internet:     100237.141@compuserve.com
  6.     AUSTRALIA         CompuServe:                  100237,141
  7.  
  8. Name    _____________________________________________________
  9.  
  10. Company _____________________________________________________
  11.  
  12. Address _____________________________________________________
  13.  
  14. Town    ________________________  State _______  Code _______
  15.  
  16. Country _____________________________________________________
  17.  
  18. Phone   __________________________  Fax _____________________
  19.  
  20. E-mail  _____________________________________________________
  21.  
  22. Where software seen or obtained _____________________________
  23. Computer:    [ ]XT   [ ]AT/286   [ ]386   [ ]486   [ ]Pentium
  24. Memory Size: ____________    Hard Disk Size: __________
  25. Drives:  [ ]5.25 360K  [ ]3.5 720K  [ ]5.25 1.2M  [ ]3.5 1.4M
  26. Screen:  [ ]Mono/Herc   [ ]CGA    [ ]EGA    [ ]VGA    [ ]>VGA
  27. DOS Ver# ________   Windows Ver# ________   OS/2 Ver# _______
  28.  _______________________________________ _______ ___________
  29. | P R O D U C T  /  L I C E N S E       | Q T Y | P R I C E |
  30. |_______________________________________|_______|___________|
  31. |                                       |       |           |
  32. |_______________________________________|_______|___________|
  33. |                                       |       |           |
  34. |_______________________________________|_______|___________|
  35. |                                       |       |           |
  36. |_______________________________________|_______|___________|
  37. |                                       |       |           |
  38. |_______________________________________|_______|___________|
  39. | T O T A L                                     |           |
  40. |_______________________________________________|___________|
  41.  
  42. [ ]AMEX  [ ]Bankcard  [ ]Mastercard  [ ]Visa   [ ]Cash/Cheque
  43.  
  44. Credit Card No  _____ _____ _____ _____   Expiry Date ___/___
  45.  
  46. Cardholder Name _____________________________________________
  47.  
  48. Signature       ___________________________   Date __________
  49.  
  50. Comments: