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Text File  |  1996-07-10  |  2KB  |  90 lines
  1.  
  2. Registration Form  - The Login Checker II 
  3. ------------------------------------------
  4.  
  5. Send to:      Tamalpais Technologies
  6.           c/o Login Checker
  7.           P.O. Box 125
  8.           Larkspur, CA  94977
  9.           
  10.  
  11. Fax to:       (415) 927-4619
  12.   
  13.  
  14. Name:         _________________________________________
  15.  
  16. Title:        _________________________________________
  17.  
  18. Company:      _________________________________________
  19.  
  20. Address 1:    _____________________________________________________
  21.  
  22. Address 2:    _____________________________________________________
  23.  
  24. City:         _____________________________ State: ________ Zip: _____________
  25.  
  26. Country:      _____________________________ (if outside the U.S.)
  27.  
  28. Phone Number: _____________________________
  29.  
  30. Disk Size:          5 1/4       3 1/2       (Circle One)
  31.  
  32. Method of Payment:  _____ Check (Inclosed)    
  33.  
  34.             _____ COD (add $2.00)  
  35.  
  36.             _____ Bill Me! (Send an Invoice) 
  37.             
  38.               PO Number - (if available):  _______________________
  39.  
  40.             _____ Credit Card (VISA OR MASTERCARD)
  41.             
  42.     Credit Card #:  ____________________________________  exp: _________
  43.  
  44.     Full name on Card: ___________________________________
  45.  
  46.     Signature: ____________________________________________
  47.  
  48.  
  49. Please register me for:
  50.  
  51.    1 To  50 users   ____________  $35                    
  52.  
  53.    51 to 100 users  ____________  $70
  54.  
  55.    101 to 150 users ____________  $105
  56.  
  57.    151 to 200 users ____________  $140
  58.  
  59.    Over 200 users   ____________  $175
  60.  
  61.  
  62.  
  63.                        
  64.              Order Total:   __________________
  65.                 
  66.                          $2.50
  67.            Shipping and Handling:   __________________
  68.     
  69.    California? (add Sales Tax 7.25%):   __________________
  70.  
  71.             COD? (add $2.00):   __________________
  72.                          
  73.                    Total:   __________________
  74.  
  75.  
  76.  
  77. Where did you hear about the Login Checker?
  78.                       
  79. _____________________________________________________________________
  80.  
  81.  
  82. Any comments about the product (New features you'd like to see?)
  83.                       
  84. _____________________________________________________________________
  85.  
  86. _____________________________________________________________________
  87.  
  88.  
  89. (10/94)
  90.