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Text File  |  1997-06-17  |  1.2 KB  |  48 lines
  1.             Support Card v2.01
  2.            Registration Form/Invoice.
  3.  
  4. Please complete this order form and mail to:
  5.  
  6.             Genesis PC-Ware
  7.                 P.O. Box 86
  8.                     Mankato, MN   56002
  9.  
  10.             <or>
  11.  
  12.     E-Mail:    jholt@prairie.lakes.com
  13.  
  14. Check form of payment:
  15.     
  16.     Check: ___    Visa: ___    Mastercard: ___
  17.  
  18. Credit card orders:
  19.  
  20.     Card Number: _______ - _______ - _______ - _______
  21.     
  22.     Card Expiration Date: ____/____
  23.  
  24.         Signature: _______________________________________
  25.  
  26. Warranty Card v2.01:quantity _____ @ $20.00 ea. = _____________
  27.  
  28. Minnesota residents add 6.25% sales tax         + _____________
  29.  
  30.                                   Total payment   _____________
  31.  
  32. Payments must be in US dollars drawn on a US bank.
  33.  
  34.             Name: ______________________________ Date: _________
  35.  
  36.          Company: ______________________________________________
  37.  
  38.          Address: ______________________________________________
  39.  
  40.                   ______________________________________________
  41.  
  42. City, State, Zip: ____________________________ Country: ________
  43.  
  44.        Day Phone: ________________ Evening Phone: ______________
  45.  
  46. E-Mail address: _______________________________________
  47.  
  48. Comments: