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Text File  |  1993-08-03  |  1KB  |  50 lines
  1.                           -=DEAD PAINT Reg. Form=-
  2.  
  3. -----
  4.  
  5. Checks or Money Orders please.
  6.  
  7. Please make checks payable to: Chung Wing Leong (my legal name)
  8.  
  9.  
  10. Send it to:      Dead Paint
  11.                  P.O. Box 2341
  12.                  Daly City, CA  94017
  13.  
  14.  
  15. To receive a registered copy, please send in $20.00 in US Funds, plus
  16. $3.00 for postage/handling.
  17.  
  18. (Outside United State orders: Please send in $5.00 for postage/handling.
  19. Also, please send in US currency)
  20.  
  21. Disk Size:     [ ]  5 1/4    [ ]  3 1/2
  22.  
  23.  
  24. Your name: ______________________________________________________________
  25.  
  26. Address:_________________________________________________________________
  27.  
  28. City,St,Zip,Country:_____________________________________________________
  29.  
  30. Phone number (voice):____________________________________________________
  31.  
  32. BBS name: ________________________ BBS Phone number: ____________________
  33.  
  34. BBS software:______________________________ Version: ____________________
  35.  
  36.  
  37.  
  38. Comments:________________________________________________________________
  39.  
  40. _________________________________________________________________________
  41.  
  42. _________________________________________________________________________
  43.  
  44. _________________________________________________________________________
  45.  
  46. _________________________________________________________________________
  47.  
  48.  
  49. Signature____________________________________   Date:____________________
  50.