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Night Owl's Shareware - PDSI-006 - Night Owl Corp (1990).iso
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INVOICE.DOC
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1991-04-15
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5KB
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118 lines
USER REGISTRATION FORM
LOANPMT COPYRIGHT (C) 1989-1991, DATA LANGUAGE SYSTEMS
ALL RIGHTS RESERVED
To register your use of LOANPMT, complete this form and mail
it along with the Invoice and your check, money order, or
charge card information to:
Data Language Systems
Attn: Donald L. Swartz
R.R.#1, Box 18A
Yorktown, Indiana 47396
(Please print) DATE: _______________ LOANPMT Ver 1.2
(Please Check One) ( ) MR., ( ) MS., or ( ) ________
NAME: _____________________________________________________
COMPANY: _____________________________________________________
STREET: _____________________________________________________
CITY: _____________________ STATE: _______ ZIP: __________
COUNTRY: _____________________________________________________
PHONE: (_________) ________________________________________
MICROCOMPUTER USED: __________________________________________
MONITOR: ( ) Monochrome ( ) Color
GRAPHICS CARD: ( ) MDA ( ) CGA ( ) EGA ( ) MCGA ( ) VGA
( ) Other __________________________________
SYSTEM PROCESSOR:
( ) 8186 ( ) 8188 ( ) NEC V20 ( ) NEC V30
( ) 8086 ( ) 8088 ( ) 80286 ( ) 80386SX ( ) 80386
( ) 80486 ( ) Other (specify)
SYSTEM MEMORY ________K. EMS MEMORY ________K.
PC/MS-DOS Ver # __________
DISK DRIVES:
# _____ 5 1/4" Floppy # _____ 3 1/2" Floppy
# _____ Hard Drives
PRINTERS:
( ) Dot Matrix ( ) Laser ( ) Other __________________
Printer brand name & model# _______________________________
HOW DID YOU ACQUIRE THIS PROGRAM:
( ) BBS ( ) User Group ( ) Shareware Library
( ) From a friend ( ) Direct from Data Language Systems
( ) Other _________________________________________________
WHAT WOULD YOU LIKE TO SEE ADDED TO THIS PROGRAM?
______________________________________________________________
______________________________________________________________
______________________________________________________________
COMMENTS:
______________________________________________________________
______________________________________________________________
______________________________________________________________
Remit to: INVOICE # 041591
Data Language Systems
R.R.#1, Box 18A
Yorktown, IN 47396
(317) 759-7367
Ship to (please print):
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
_________________________________________________
UNIT
PRICE
DESCRIPTION QTY (U.S.$) TOTAL
LOANPMT Ver 1.1
registration fee. _____ $15.00 ___________
LOANPMT (5 1/4", 360K)
distribution disk. _____ $5.00 ___________
DIRSRCH (5 1/4", 360K)
distribution disk. _____ $5.00 ___________
SUB TOTAL: ___________
SALES TAX (Indiana Residents) 5% ___________
Shipping & Handling - (No charge for 1st Class Mail
to US, Canada, & Mexico, but $5.00 per distribution
disk for Air Mail to all other locations) ___________
TOTAL: ___________
Please send payment for total amount in U.S. funds only.
Method of payment (check one):
( ) Check ( ) Money Order ( ) MasterCard ( ) Visa
Charge card users must fill in the following, or you may phone
us at the number shown above from 5:00PM-9:00PM EST:
Account No. _______ _______ _______ _______ Exp. Date _______
MasterCard only, four digit ICA number _______________________
Signature: ___________________________________________________
(required for all charge cards)