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/ Gold Medal Software 4 / Gold Medal Software - Volume 4 (Gold Medal) (1994).iso / virus / ajvir221.arj / REGISTER.DOC < prev   
Text File  |  1994-02-24  |  2KB  |  62 lines
  1.       ARJVIR REGISTER FORM     Prices subject to change without notice.
  2.  
  3.     TO:                                   
  4.         Delrey Cybernetics
  5.         1267 Lionel-H.-Grisé  
  6.         St-Bruno, Qc, CANADA
  7.         J3V 4W3
  8.     
  9.     FROM:
  10.       
  11.       Name: ________________________________________________________
  12.              
  13.        Address: ____________________________________________________
  14.  
  15.       City: ________________________________________________________
  16.  
  17. State/Province: _________________________ Zip Code: ________________
  18.  
  19.        Country: ___________________________ Phone: _________________
  20.  
  21.     
  22.     CONDITIONS:
  23.       Payment must be made in cash, or International Money Order 
  24.       in CANADIAN funds to Delrey Cybernetics.
  25.     
  26.     ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
  27.     
  28.     INDIVIDUAL REGISTRATION for the use of ARJVIR 
  29.     1 registration is 10.00$                         ____x(10.00$):______
  30.  
  31.     Shipping and handling                            ____x(5.00$):_______  
  32.  
  33.                                                  TOTAL ENCLOSED   _______
  34.  
  35.     Payment method:   [] Cash          [] Money order
  36.     
  37.     Disk format:      [] 5.25 (1.2Meg) [] 3.5 (1.44 Meg) [] Other _______        
  38. or  Internet address to send the files:__________________________________ 
  39.  
  40.     SIGNATURE: _____________________________________ DATE: ______________
  41.  
  42.     ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
  43.     
  44.     Please let us know about...
  45.  
  46.     1)  How did you find out about ARJVIR?
  47.  
  48.     Friend.. []      
  49.     BBS..... []
  50.     Network. [] Which:______________________________________________
  51.     Other... [] ____________________________________________________
  52.  
  53.     2)  What would you like to see in future releases of ARJVIR?
  54.  
  55.    ______________________________________________
  56.    ______________________________________________
  57.    ______________________________________________
  58.    ______________________________________________
  59.  
  60. dc/arjvir221
  61.  
  62.