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Text File  |  1993-06-08  |  1KB  |  45 lines
  1.                              TEXLOTTO REGISTRATION
  2.                  .........................................
  3.                               Derrick Hagler
  4.                             Post Office Box 237c
  5.                             Blue Ridge, TX 75424
  6.                             214-752-5556
  7.  
  8.  
  9.                               Date   /  /
  10.  
  11.  
  12.  Name ___________________________________
  13.  
  14.  Company ________________________________
  15.  
  16.  Address ________________________________
  17.  
  18.  City ________________________ State ________________ Zip ____________
  19.  
  20.  Phone (   )-   -   ext.
  21.  ---------------------------------------------------------------------------
  22.  
  23.  Comments: ___________________________________________________________
  24.  
  25.            ___________________________________________________________
  26.  
  27.            ___________________________________________________________
  28.  
  29.  ---------------------------------------------------------------------------
  30.  
  31.  Registration for this program is $5.00 (U.S. funds only)
  32.  
  33.  Please mail you this form along with your check or money order (no cash)
  34.  to:
  35.  
  36.                          Derrick Hagler
  37.                          Post Office Box 237c
  38.                          Blue Ridge ,tx 75424
  39.  
  40.  
  41.  
  42.  
  43. <EOF>
  44.  
  45.