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Text File  |  1995-08-04  |  2KB  |  53 lines
  1.  
  2.                    .....   GolfLog Registration Form   .....
  3.  
  4.      Remit To:  RiverBend SoftWare                       Tel: 501-563-2892
  5.                 P.O. Box 671
  6.                 Osceola, AR 72370-0671  USA
  7.      =====================================================================
  8.  
  9.      ____ GolfLog Registration(s) @ $32.95 each ............   ______.____
  10.  
  11.      ____ GolfTour Registration(s) @ $69.95 each ...........   ______.____
  12.  
  13.      ____ GolfClub Registration(s) @ $98.95 each ...........   ______.____
  14.  
  15.      ____ 3.5" disk instead of 5.25" ADD $3.00 .............   ______.____
  16.  
  17.      ____ Shipping/Handling inside U.S.A. ($5.00/copy) .....   ______.____
  18.  
  19.      ____ Shipping/Handling outside U.S.A. ($7.50/copy) ....   ______.____
  20.  
  21.      ____ Arkansas residents ($6.5% Tax per copy) ..........   ______.____
  22.  
  23.           TOTAL ............................................ $ ______.____
  24.  
  25.          ** Orders without S/H charges included will not be shipped! **
  26.  
  27.      Check one:  [ ] Check/M.O.(U.S. Bank)    [ ] Visa      [ ] MasterCard
  28.  
  29.        Name: ____________________________________________________________
  30.                        (Name program is to be registered to)
  31.  
  32.      Address: ____________________________________________________________
  33.  
  34.               ____________________________________________________________
  35.  
  36.         City: __________________________ State/Prov: _____________________
  37.  
  38.      Country: __________________________ Zip/Postal Code: ________________
  39.  
  40.      Home Phone  (____) ________________ Work Phone  (____) ______________
  41.  
  42.                       ..... Credit Card Information .....
  43.  
  44.      Name on Card: _______________________________________________________
  45.                             (Must be exactly as shown on card)
  46.  
  47.      Card Number:  _______  _______  _______  ________   EXPIRES ____/____
  48.                                                                   MM / YY
  49.      Signature:    _______________________________________________________
  50.                                Required if using Credit Card
  51.  
  52. [v9.5n]
  53.