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Text File  |  1996-12-14  |  2.8 KB  |  78 lines
  1.                           Flax Software Order Form
  2.   -------------------------------------------------------------------------
  3.  
  4.    Sysops Name    : [_____________________________________________________]
  5.  
  6.    BBS Name       : [_____________________________________________________]
  7.  
  8.    BBS Number     : (______)________-___________
  9.  
  10.    E-Mail Address : [_____________________________________________________]
  11.  
  12.    Postal Address : [_____________________________________________________]
  13.  
  14.                     [_____________________________________________________]
  15.  
  16.                     [_____________________________________________________]
  17.  
  18.                     [_____________________________________________________]
  19.  
  20.  
  21.    Receive Methods                               Tick
  22.   -------------------------------------------------------------------------
  23.  
  24.    Receive by Post                               [__]
  25.    Receive by Internet E-Mail                    [__]
  26.  
  27.  
  28.  
  29.   Software Package                         Price              Tick
  30.  ---------------------------------------------------------------------------
  31.  
  32.   Sickchat Sysop Chat Package (for PCB)     $20               [__]
  33.   Sicknews News Generator                   $10               [__]
  34.  
  35.   Both Sickchat and Sicknews                $25               [__]
  36.  
  37.   Postage + Handling (Postal Orders)       + $5               [__]
  38.  
  39.                                          ----------
  40.                Total Amount Enclosed:     $
  41.                                          ----------
  42.  
  43.    Payment Methods
  44.   -------------------------------------------------------------------------
  45.  
  46.              Cash (at own risk!)               [__]
  47.              Bank Draft                        [__]    (Tick One)
  48.              Money (postal) Order              [__]
  49.              Personal Cheque (Australia Only)  [__]
  50.  
  51.   Bank Drafts, Cheques and Money Orders should be made out to "Beau Barker",
  52.   and MUST BE IN AUSTRALIAN FUNDS.
  53.  
  54.  
  55.    Declaration
  56.   -------------------------------------------------------------------------
  57.  
  58.   Upon receipt of the registered software, I hereby promise to be the only
  59.   person using it. I understand that if I distribute any of the software or
  60.   registration codes I receive I will be in violation of this agreement and
  61.   may have legal action taken against me.
  62.  
  63.  
  64.  
  65.        ____________________________________________    ____/____/____
  66.          signature - in ink                              date
  67.  
  68.  
  69.  
  70.  
  71.  -------8<------------Cut------------8<------------Cut------------8<-------
  72.  
  73.   Print and send completed form to:  Flax Software
  74.                                      PO Box 123
  75.                                      Caulfield East
  76.                                      Australia 3145
  77.  
  78.