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orderfrm.txt
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Text File
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1994-03-11
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3KB
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56 lines
REGISTRATION/ORDER FORM
To: ARK ANGLES Phone: Intl+61 47 588100
24 Alexander Ave Fax: Intl+61 47 588638
Hazelbrook NSW 2779 CIS: 100237,141
AUSTRALIA
From: Name ___________________________________________________________
Company ___________________________________________________________
Address ___________________________________________________________
Town ____________________________ State ________ Code ________
Country ___________________________________________________________
Phone ____________________________ Fax _________________________
Where did you obtain or hear about the software? ________________________
Computer: [ ] XT [ ] AT/286 [ ] 386 [ ] 486 [ ] >486
Memory Size: ____________ Hard Disk Size: __________
Drives: [ ] 360K 5.25" [ ] 720K 3.5" [ ] 1.2M 5.25" [ ] 1.44M 3.5"
Screen: [ ] Mono/Herc [ ] CGA [ ] EGA [ ] VGA [ ] >VGA
Dos Version: _______ Windows Version: _______ OS/2 Version: _______
___________________________________________________ _______ ___________
| P R O D U C T / L I C E N S E | Q T Y | P R I C E |
|___________________________________________________|_______|___________|
| | | |
|___________________________________________________|_______|___________|
| | | |
|___________________________________________________|_______|___________|
| | | |
|___________________________________________________|_______|___________|
| | | |
|___________________________________________________|_______|___________|
| | | |
|___________________________________________________|_______|___________|
| T O T A L | |
|___________________________________________________________|___________|
[ ] Bankcard [ ] Mastercard [ ] Visa [ ] Cash/Cheque/Draft/Order
Credit Card No _______ _______ _______ _______ Expiry Date ____ / ____
Cardholder Name _________________________________________________________
Signature _______________________________ Date __________________
Comments: