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Text File  |  1992-07-29  |  1KB  |  49 lines
  1.                WinKey Registration Form
  2.  
  3.                Please mail to:
  4.                 DataGem Corp.
  5.             1420 NW Gilman # 2859
  6.               Issaquah, WA 98027
  7.  
  8.  
  9. Name:            ________________________________________
  10.  
  11. Company:        ________________________________________
  12.  
  13. Address:        ________________________________________
  14.  
  15.             ________________________________________
  16.  
  17. City/State/Zip:        _______________________ ___ ____________
  18.  
  19. Country:        ___________________________
  20.  
  21. Daytime telephone:    ___________________________
  22.  
  23. Current WinKey Version:    ___________________________
  24.  
  25. Date:            ___________________________
  26.  
  27. Medium:  3 1/2 inch diskette ( )   5 1/4 diskette ( )
  28.  
  29. Payment (US Funds only):
  30.  
  31.     Check or money order ( ) $15.00        
  32.     COD             ( ) $20.00
  33.     MasterCard           ( ) $15.00
  34.     Visa              ( ) $15.00
  35.  
  36. Credit card number: ____________________________  Expires: ______
  37.  
  38.  
  39.  
  40. Credit card signature: ___________________________
  41.  
  42. Purchase price from above: _____ copies @ ____________ = ________
  43.                                
  44. Washington residents add 8.2% (or ____ %) sales tax:     ________
  45.  
  46. Total:                             ________
  47.  
  48. Comments/Requests:
  49.