home
***
CD-ROM
|
disk
|
FTP
|
other
***
search
/
Media Share 9
/
MEDIASHARE_09.ISO
/
pcboard
/
purge11.zip
/
REG.TXT
< prev
Wrap
Text File
|
1992-10-09
|
2KB
|
47 lines
Registration Form For Purge
───────────────────────────
Your Full Name ________________________________________
Street Address ________________________________________
City, State, Zip ________________________________________
Voice Phone Number ________________________________________
(Optional)
Name of Your BBS ________________________________________
BBS Phone Number ________________________________________
Comments/Suggestions ________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
Cost for registration is $20.00 Please make checks payable
to Ray Novino and mail to:
Ray Novino
PO Box 0941
Lansdowne, PA 19050
We also Accept Visa, Master Card, Discover, and Dinners Club
Credit Card Number __________________________________________
Expiration Date ________________________
Signature of Card Holder __________________________________________