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Text File  |  1988-04-23  |  4KB  |  50 lines
  1.   _________________________________________________________________________
  2.  |                                                                         |
  3.  |            DLS Development  Draw2Me  USER REGISTRATION FORM             |
  4.  |                             INSTRUCTIONS:                               |
  5.  |    Fill out all of the information on the attatched form completely and |
  6.  | legibly. (Print or type.)  And send it to:                              |
  7.  |                            DLS Development                              |
  8.  |                             One Gale Road                               |
  9.  |                           Brick, NJ,  08723                             |
  10.  |-------------------------------------------------------------------------|
  11.  |                                                                         |
  12.  | COMPANY:...........................................................     |
  13.  |                                                                         |
  14.  | LAST NAME:.........................................................     |
  15.  |                                                                         |
  16.  | FIRST NAME.............................  MIDDLE INIT:..............     |
  17.  |                                                                         |
  18.  | ADDRESS:...........................................................     |
  19.  |                                                                         |
  20.  | CITY:........................  STATE:.........  ZIP:...............     |
  21.  |                                                                         |
  22.  | HOME TELEPHONE #:(..........)-(..............)-(...................)    |
  23.  |                                                                         |
  24.  | BUS. TELEPHONE #:(..........)-(..............)-(...................)    |
  25.  |                                                                         |
  26.  | PLEASE CHECK ONE:    MONEY ORDER [ ]        CHECK [ ]      VISA [ ]     |
  27.  |                 AMERICAN EXPRESS [ ]   MASTERCARD [ ]    C.O.D. [ ]     |
  28.  | (Make payment for $89.95, plus $10.00 for shipping and handling.)       |
  29.  | (In New Jersey, please add 6% sales tax.  Add $5.00 for C.O.D.)         |
  30.  |                                                                         |
  31.  | Card Number ................................ Exp.Date............       |
  32.  |                                                                         |
  33.  | AMOUNT INCLUDED (OR CHARGED TO Card):  $.............................   |
  34.  |                                                                         |
  35.  |    I have read and agree to the limited software license agreement      |
  36.  | included in the README.DOC of this program.                             |
  37.  |                                                                         |
  38.  | SIGNATURE:.................................... DATE:.................   |
  39.  | ----------------below is intended for office-use only------------------ |
  40.  |                                                                         |
  41.  | USER REGISTRATION NUMBER:.............................................. |
  42.  |                                                                         |
  43.  | DATE OF OFFICIAL REGISTRATION:......................................... |
  44.  |                                                                         |
  45.  | TELEPHONE ASSISTANCE CHECK (MINUTES): ...........  ...........          |
  46.  |                                       ...........  ...........          |
  47.  |                                       ...........  ...........          |
  48.  |_________________________________________________________________________|
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