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Text File  |  1995-10-29  |  2KB  |  44 lines
  1. YOU MAY EDIT THIS FORM AND PRINT, OR PRINT AND COMPLETE IN PEN
  2. ----------------------------------------------------------------
  3. Mail-in Registration Form
  4.  
  5. I would like to purchase the product(s) shown below.  Please ship
  6. a licensed version to the following address:
  7.  
  8. NAME    ________________________________________________________    
  9.  
  10. ADDRESS ________________________________________________________
  11.  
  12.     ________________________________________________________
  13.  
  14. CITY_______________________STATE____ZIP________COUNTRY__________
  15.  
  16. DAYTIME PHONE (___)____-_______  EVENING PHONE (___)____-_______
  17.                  
  18.                  QUANTITY  UNIT PRICE     COST
  19.                  --------  ----------    ------
  20. PlanStar                           _____  X  $49.00  =  $______
  21. CallStar                           _____  X  $20.00  =  $______
  22. PlanStar Gold (both of the above)  _____  X  $69.00  =  $______
  23.      SUBTOTAL                                           $______
  24.      VA Residents add 4.5%                              $______
  25.      Shipping (US $0, Canada $2, Elsewhere $5)          $______
  26.      TOTAL                                              $______
  27.      
  28.  
  29. PAYMENT MADE BY:
  30.  
  31. ____CHECK, drawn on an American Bank, made payable to HENNING ASSOCIATES.
  32.  
  33.     MAIL TO:  Henning Associates
  34.           Rt. 2, Box 526-A
  35.           Crozet, VA  22932
  36.  
  37. ____CREDIT CARD
  38.  
  39.     ____VISA    ____MasterCard
  40.  
  41.     Card number _________________________________________________________
  42.  
  43.     Expiration date ____/____   Signature:_______________________________
  44.