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Monster Media 1996 #15
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Monster Media Number 15 (Monster Media)(July 1996).ISO
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lsrcmp12.zip
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REGISTER.FRM
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1996-06-01
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>> LASERCOMPARE Registration form by Jason Laviska << PLEASE PRINT LEGIBLY.
[Personal Information] Your Real Name:_____________________________________
Your Mailing Address:_______________________________________________________
City:__________________________ State:_________________ Zip:______________
Country:_______________________ Voice Phone: (_______) ________-___________
Do you own a BBS? _____ (If YES) BBS Name:_________________________________
Registered To:______________________________________________________________
(40 Characters Maximum) (Include your real name and business name, if any)
Where did you obtain this program?__________________________________________
Name/Description Unit Price Total
REGISTRATION KEY for LASERCOMP..................... $10.00 = $ _______
Florida residents add applicable sales tax......... = $ _______
Shipping and handling, if outside United States.... $ 2.00 = $
=======
(Payment must be in United States funds only) Grand Total $ _________
Please Select one method of payment:
[ ] I will be paying with a check payable to "Jason Laviska"
NOTE: Personal checks MUST be cleared prior to shipment.
[ ] I will be paying with a money order payable to "Jason Laviska"
Upon receipt of the registration key(s), I hereby promise that I will be the
only one using this key(s). I will not give it out to anybody, no matter how
much they beg and/or cry, it is for my use only. I understand that if I give
this key out, or it is removed from my possession, I am in violation of this
agreement. I also understand that upon violation of this agreement, legal
action may be taken against myself.
SIGNATURE:__________________________________________ ____ / ____ / ________
(Sign in INK) (Today's Date)
(Leave any comments on the back of this form) Thank-You For Registering!
----------------------------------------------------------------------------
Mail the Registration form along with your check or money order to:
LaserCompare Registration
Jason Laviska
510 Tupelo Drive
Melbourne, FL 32935-6371