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Text File  |  2000-07-08  |  979 b   |  43 lines
  1. Registration form for BigClock fontchanger
  2.  
  3.  
  4. Program No.: 102911
  5.  
  6. Last name: ___________________________________
  7.  
  8. First name: ____________________________________
  9.  
  10. Company: ____________________________________
  11.  
  12. Street and #: ______________________________________
  13.  
  14. City, State, postal code: ________________________________
  15.  
  16. Country: _______________________________________
  17.  
  18. Phone: _____________________________________
  19.  
  20. Fax: ________________________________________
  21.  
  22. E-Mail: ______________________________________
  23.  
  24.  
  25. How would you like to pay the registration fee of $10:
  26.  
  27. credit card - wire transfer - EuroCheque - cash
  28.  
  29.  
  30. Credit card information (if applicable)
  31.  
  32. Credit card: Visa - Eurocard/Mastercard - American Express - Diners Club
  33.  
  34. Card holder: ________________________________
  35.  
  36. Card No.: ___________________________________
  37.  
  38. Date of Expiration : ___________________________________
  39.  
  40.  
  41.  
  42. Date / Signature ___________________________
  43.