home *** CD-ROM | disk | FTP | other *** search
/ Gold Medal Software 3 / Gold Medal Software - Volume 3 (Gold Medal) (1994).iso / misc / grocer36.arj / ORDER.FRM < prev    next >
Text File  |  1994-04-30  |  876b  |  26 lines

  1.          Invoice Code: Sztyz+Fienfx
  2.  
  3.          Please add me as a supporter of THE GROCER, version 3.6b:
  4.  
  5.  
  6.     Name    ______________________________________________________________
  7.  
  8.     Company ______________________________________________________________
  9.  
  10.     Address ______________________________________________________________
  11.  
  12.             ______________________________________________________________
  13.  
  14.     City    ________________________________State _______ Zip ____________
  15.  
  16.  
  17.     Amount  $12.50_x____copies_=_________________   Date   _______________
  18.  
  19.  
  20.    
  21.                                                       Please Mail To:
  22.  
  23.                                                       Richard Zakas
  24.                                                       4205K Bland Rd.
  25.                                                       Raleigh, NC  27609
  26.