home *** CD-ROM | disk | FTP | other *** search
/ Game Head 1996 January / Game Head January 1996.iso / dos / wrath / orderfrm.txt < prev    next >
Encoding:
Text File  |  1995-10-05  |  2.5 KB  |  61 lines
  1.                             ***********************
  2.                             CEREBRAL GAMING SYSTEMS
  3.  
  4.  Name________________________________________________________________________
  5.  
  6.  Company_____________________________________________________________________
  7.  
  8.  Address_____________________________________________________________________
  9.  
  10.  City__________________ State______ ZIP_________ Country_____________________
  11.  
  12.  Daytime Phone_________________________ Fax__________________________________
  13.  
  14.                                                        PRICE
  15.  ITEM NUMBER            DESCRIPTION             QTY.   EACH      TOTAL
  16.  
  17.  ___________ ______________________________________ ____ _________ __________
  18.  
  19.  ___________ ______________________________________ ____ _________ __________
  20.  
  21.  ___________ ______________________________________ ____ _________ __________
  22.  
  23.  ___________ ______________________________________ ____ _________ __________
  24.  
  25.  ___________ ______________________________________ ____ _________ __________
  26.  
  27.  ___________ ______________________________________ ____ _________ __________
  28.  
  29.  ___________ ______________________________________ ____ _________ __________
  30.  
  31.  ___________ ______________________________________ ____ _________ __________
  32.  
  33.    A000-001  Battle Wrath Fan Club - 1 Year Memb.    ____   $15.00 __________
  34.  
  35.  Payment Method                                      
  36.                                                      SUB-TOTAL ______________
  37.  [ ] Check or Money Order (U.S. Funds)               
  38.  [ ] VISA                                             SHIPPING 
  39.  [ ] Mastercard                        ($1.00/Disk, $5.00 Max) ______________          
  40.                                                                
  41.  Account Number___________________________           SALES TAX         
  42.                                               (N.C. Residents) ______________ 
  43.  Expiration Date__________________________
  44.                                                          
  45.  All disks are 3 1/2 inch 1.44 megabyte                  TOTAL ______________
  46.  
  47. Make checks payable to Cerebral Gaming Systems.
  48. U.S. funds only. No C.O.D.s accepted. Do not send cash.
  49. Int'l rates vary. Contact Cerebral prior to ordering.
  50.  
  51. WHERE TO ORDER CEREBRAL GAMING SYSTEMS PRODUCTS:
  52.  
  53.       U.S. Mail: Cerebral Gaming Systems
  54.                  P.O. Box 10552
  55.                  Raleigh, N.C. 27605
  56.                  Attn: Ordering
  57.  
  58.             Fax: (919)-876-3098
  59.           Phone: (919)-850-9900
  60.             WWW: http://web.sunbelt.net/battlewrath
  61.