home *** CD-ROM | disk | FTP | other *** search
/ PC Team 23 / HS_Tuning.iso / Optimisation / Registry Doctor 1.0 / rdsetup.exe / {app} / regdoc.chm / orderform.txt < prev    next >
Encoding:
Text File  |  2003-05-08  |  1.3 KB  |  48 lines
  1. Print this form and fill out all applicable fields below.
  2.  
  3. Fax to:
  4. 801-497-9456
  5.  
  6. Mail to: (checks payable to Emetrix)
  7. Emetrix
  8. ATTN: Sales
  9. 1648 Willow Dr
  10. Kaysville UT 84037
  11. USA
  12.  
  13. Name    _____________________________________________________
  14.  
  15. Address    _____________________________________________________
  16.  
  17.     _____________________________________________________
  18.  
  19. City    _____________________________________________________
  20.  
  21. State    _____________________________________________________
  22.  
  23. ZipCode    _____________________________________________________
  24.  
  25. Country    _____________________________________________________
  26.  
  27. Phone    _____________________________________________________
  28.  
  29. Fax    _____________________________________________________
  30.  
  31. Email    _____________________________________________________
  32.  
  33. Credit Card Info: (if applicable)
  34.  
  35. [ ]Visa  [ ]MasterCard  [ ]American Express [ ]Discover
  36.  
  37. Number    ___________________________________ Exp______________
  38.  
  39. Product Information:
  40.  
  41. Product    Name    Registry Doctor (PID: 1712383)
  42.  
  43. Quantity        _____________________________________________
  44.  
  45. Product Price    _____________________________________________
  46.  
  47. Delivery Option _____________________________________________
  48. (check product info for available options and pricing)