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REG103
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Text File
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1990-08-21
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2KB
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73 lines
CMORT103 REGISTRATION FORM
--------------------------
NAME: ________________________________________________________
COMPANY: _______________________________________________________
ADDRESS: _______________________________________________________
_______________________________________________________
STATE: ____________________________ZIP CODE___________________
PHONE: _______________________________________________________
WHERE DID YOU RECEIVE THIS PROGRAM______________________________
COMMENTS:_______________________________________________________
_______________________________________________________
_______________________________________________________
Basic Registration @ $60.00 $___________________
Includes ONE 5.25 inch disk.
(Add $5.00 if you want a 3.5 inch disk.)
Add $5.00 for each additional 5.25 inch disk.
Additional 5.25 inch disks. #_______@ $5.00 ___________________
Add $8.00 for each additional 3.5 inch disk.
Additional 3.5 inch disks. #_______@ $8.00 ___________________
Sub Total $___________________
Connecticut Residents Add 8 % Sales Tax ___________________
Total $___________________
Remit To: Mangeri Agency
41 Yale Drive
Enfield, CT 06082