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Text File  |  1991-09-20  |  2KB  |  48 lines
  1.  
  2.                         DYNAGEN (tm) Registration Form
  3.  
  4.                                   DYNASOFT (tm)
  5.                                  PO Box 1836
  6.                              Elyria, OH 44036 USA
  7.  
  8.                             Phone: (216) 365-9667
  9.                                   FAX: TBA
  10.                             CompuServe: 73737,1761
  11.  
  12.  
  13.   Name _____________________________________________  Today's Date ___________
  14.  
  15.   Company ____________________________________________________________________
  16.  
  17.   Title ______________________________________________________________________
  18.  
  19.   Address ____________________________________________________________________
  20.  
  21.   City _________________________  State ______________  ZIP Code _____________
  22.  
  23.   Country __________________  FAX __________________  Phone __________________
  24.  
  25.                                 Thru 12/1/91    After 12/1/91
  26.      # of PCs   Copies   Times  Price/PC/Site   Price/PC/Site     Amount
  27.      --------   ------   -----  -------------   -------------   ---------
  28.            1    ______     X       $69.00           $79.00      $ _______
  29.         2-20    ______     X        64.00            74.00        _______
  30.        21-50    ______     X        59.00            69.00        _______
  31.       51-100    ______     X        54.00            64.00        _______
  32.         100+    ______     X        49.00            59.00        _______
  33.  
  34.                          Shipping & Handling (single package)
  35.                            $3.00 in US & Canada                   _______
  36.                            $5.00 outside US & Canada              _______
  37.                          Call DYNASOFT for bulk orders            _______
  38.  
  39.                     Subtotal (total $ for DYNAGEN + shipping)   $ _______
  40.  
  41.      Subtotal - Subtract $10.00 if registering before 12/1/91   $ _______
  42.  
  43.                       Ohio residents add 6.0% state sales tax     _______
  44.                                             (Subtotal * 1.06)
  45.  
  46.                                                   Grand Total   $ _______
  47.  
  48.