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Text File  |  1995-10-20  |  4KB  |  80 lines
  1. **************************************************************************
  2. *                                                                        *
  3. *                     Paper Route Ledger - Version 1.50                  *
  4. *                    Professional Carrier - Version 1.20                 *
  5. *                 Copyright 1994,95  by BlueCollar Software              *
  6. *                                                                        *
  7. *                         Published exclusively by:                      *
  8. *                           RMH Computer Services                        *
  9. *                                PO Box  657                             *
  10. *                         Beech Grove IN 46107-0657                      *
  11. *                              (317)  782-9903                           *
  12. *                                                                        *
  13. **************************************************************************
  14.  
  15.                                  ORDER FORM
  16.  
  17. --------------------------------------------------------------------------
  18.  Send registration     RMH Computer Services           [  you can call   ]
  19. form and payment to:   PO BOX 657                      [  317-782-9903   ]
  20.                        BEECH GROVE, IN 46107-0657      [  to order via   ]
  21.                        USA                             [ VISA/MasterCard ]
  22. --------------------------------------------------------------------------
  23.  
  24.  I have enclosed (US Funds) for the following product:
  25.          [ ] Paper Route Ledger   -  $19.00
  26.          [ ] Professional Carrier -  $59.00  ................... $_____
  27.  
  28.  Indiana residents must add 5% State sales tax ................. $_____
  29.  
  30.  Shipping/Handling ............................................. $_____
  31.    [ ] USA residents please add .............. $3.00 S/H
  32.    [ ] Canada/Mexico residents please add .... $5.00 S/H
  33.    [ ] Other residents please add ............ $8.00 S/H
  34.  
  35.                                         Total .................. $_____
  36.  
  37.  
  38. PLEASE TYPE OR PRINT (all information will remain confidential)
  39.  
  40. Name...: __________________________________________________________
  41.  
  42. Address: __________________________________________________________
  43.  
  44.        : __________________________________________________________
  45.  
  46.        : __________________________________________________________
  47.  
  48. Phone Number (Required)..: ___________________    Sales Code: PRL150JCSM
  49.  
  50. Do you have an email account? [y/n]: ____  
  51.    If yes, address: ____________________________________________________
  52.  
  53. I would like to receive:  [___] 3-1/2" disks (720k)
  54.                           [___] 5-1/4" disks (360k)  
  55.  
  56.  
  57.  
  58. CREDIT CARD ORDERS
  59. ------------------
  60.  
  61. For fast Credit Card (MC/VISA) ordering, please call us at 317-782-9903. 
  62. Or, you can provide the information (including your signature!) in the 
  63. space below. *ALL* spaced must be completed:
  64.  
  65.    +------------------------------------------------------------------+ 
  66.    | We can accept MasterCard or Visa credit card payments.  Fill out | 
  67.    | the following ONLY if you are making payment by MC or Visa.      | 
  68.    |                                                                  | 
  69.    | MasterCard [_]    Visa [_]    Discover [_]                       | 
  70.    |                                                                  | 
  71.    | Number on Card   [____  ____  ____  ____]   | 
  72.    |                                                                  | 
  73.    | Name on the Card [_____________________________________________] | 
  74.    |                                                                  | 
  75.    | Expires [_______]  Signature (*)________________________________ | 
  76.    +------------------------------------------------------------------+ 
  77.             (*) NOTE: This *REQUIRES* a hand-written signature! 
  78.  
  79.  
  80.