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Text File  |  1995-10-05  |  1.0 KB  |  40 lines
  1. Product:  Escape! 2.0
  2. ____________________________________________________________________
  3.  
  4. Name:
  5. [1]
  6. [2]
  7. [3]
  8. Phone/FAX:   [4]       [5]
  9.  
  10. Email:   [6]
  11.  
  12. Comments:   [7]  
  13.  
  14. Payment Method:
  15. [8]
  16. [9]
  17. [10]
  18. [11]
  19.  
  20. Signature (when sending via standard mail):___________________________________
  21.  
  22. Price per copy............:   $10.00
  23. Number of copies........:   [12]
  24. Quantity Discount.......:   [13]
  25. Send Latest?...............:   [14]
  26. Sales Tax (CA Only)...:   [15]
  27.  
  28. Total Due....................:   [16]
  29.  
  30. [17]
  31. ____________________________________________________________________
  32. FAX, send via standard mail or email this registration form to:
  33.  
  34. John V. Holder                                                           Email addresses (AOL is preferred):
  35. 2862 Lowell Street                                                   America Online:  JohnHolder
  36. Eureka, CA  95501-4315                                         Internet...........:  JohnHolder@aol.com
  37. USA                                                                            CompuServe....:  75040,1126
  38.  
  39. FAX:  (707) 443-3813
  40.