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Text File  |  1990-08-21  |  2KB  |  73 lines
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  9.                             CMORT103 REGISTRATION FORM
  10.                             --------------------------
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  13.          NAME:   ________________________________________________________
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  15.          COMPANY: _______________________________________________________
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  17.          ADDRESS: _______________________________________________________
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  20.                   _______________________________________________________
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  22.          STATE:   ____________________________ZIP CODE___________________
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  24.          PHONE:   _______________________________________________________
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  26.          WHERE DID YOU RECEIVE THIS PROGRAM______________________________
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  28.          COMMENTS:_______________________________________________________
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  30.                   _______________________________________________________
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  32.                   _______________________________________________________
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  34.          Basic Registration @ $60.00                 $___________________
  35.          Includes ONE 5.25 inch disk.
  36.          (Add $5.00 if you want a 3.5 inch disk.)
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  38.          Add $5.00 for each additional 5.25 inch disk.
  39.          Additional 5.25 inch disks. #_______@ $5.00  ___________________
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  41.          Add $8.00 for each additional 3.5 inch disk.
  42.          Additional 3.5 inch disks.  #_______@ $8.00  ___________________
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  44.                                            Sub Total $___________________
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  46.          Connecticut Residents Add 8 % Sales Tax      ___________________
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  48.                                                Total $___________________
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  52.                  Remit To:             Mangeri Agency
  53.                                         41 Yale Drive
  54.                                       Enfield, CT  06082
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