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ORDER3.FRM
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1992-07-29
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3KB
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88 lines
(make checks payable to PC+ Company)
============================================
= =
= PC+ Company =
= 9606 N.E. 4th Street =
= Midwest City, OK 73130 =
= =
============================================
phone: (405) 741-4705 messages
** COMMENTS OR SUGGESTIONS ARE WELCOME **
NAME : _____________________________________________________________
Enter your name EXACTLY the way you want on the
registration screen.
ADDRESS : _____________________________________________________________
_____________________________________________________________
___________________________________________ ZIP :____________
COMMENTS : _____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Qty
[ ] 3_Drives.HHD x $20.00
[ ] 4_Drives.HDD x $30.00
Payment: [ ] Visa (see below) [ ] Check
[ ] Cash [ ] Money Order
Total amount enclosed or authorized: $___________
_______________________________________________________________________
Payment by Visa card:
We can only accept Visa cards (no American Express or MasterCards, please.)
We will need the following information:
Credit card number: ______________________________________________________
Expiration date: _________________________________________________________
Bank the card's drawn on: ________________________________________________
The name as it appears on the card: ______________________________________
The signature of its owner authorizing us
to debit it for the amount indicated above: ______________________________
_______________________________________________________________________
THE FOLLOWING INFORMATION IS NOT REQUIRED,
BUT WOULD BE APPRECIATED.
Please Check The Appropriate Answer.
HOW DID YOU ACQUIRE THIS PROGRAM: _____________________________________
COMPUTER 286 ( ) 386 ( ) 486 ( ) OTHER ( ) ______________________
VIDEO CARD Standard VGA ( ) Super VGA ( ) Coproccessed S3 ( )
MOUSE YES ( ) NO ( )
JOYSTICK YES ( ) NO ( )
MEMORY 640 ( ) 1 meg ( ) 2 meg ( ) 3 meg ( ) more ( ) ______
HARD DISK MAKE ______________________________________________________
MODEL______________________________________________________
SIZE ______________________________________________________
CONTROLLER ________________________________________________
** Please list all drives.
MODEM YES ( ) NO ( ) .... BAUD RATE ___________________________