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Text File  |  1993-08-27  |  1KB  |  38 lines
  1. ********************************************************************
  2.                   MedTxt version 1.0 Order Form 
  3. ********************************************************************
  4.  
  5. Send registration fee to:
  6. Dudley Darr
  7. 6352 Clinton Highway
  8. Knoxville, Tn 37912
  9. USA
  10.  
  11. Please send me by check or money order:
  12.  
  13. _____ MedTxt Version 1.0 ........................@ $25.00 ea $ _____
  14.  
  15. Shipping and Handling....US/Canada/Mexico: $5; Overseas: $10 $ _____
  16.  
  17.                   TOTAL (U.S. Funds drawn on    U.S. Bank)   $ _____
  18.                      
  19. Name: ______________________________________________________
  20.  
  21. Address: ___________________________________________________
  22.  
  23.        : ___________________________________________________
  24.        
  25.        : ___________________________________________________
  26.        
  27.        : ___________________________________________________
  28.        
  29. Phone: ___________________________
  30.  
  31. I need _____ 5 1/4" disks ______ 3 1/2" disks.
  32.  
  33. I received this program from: ______________________________________
  34.  
  35.                               ______________________________________
  36.                               
  37.                               ______________________________________
  38.