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Text File  |  1993-10-09  |  1KB  |  36 lines
  1.     
  2.      
  3.      APPLICATION FOR RECEIVING COMMISSION CHECKS
  4.      
  5.      
  6.      COMPANY NAME: ..................................................
  7.      
  8.      NAME: ................................. DATE OF BIRTH: .........
  9.      
  10.      ADDRESS: .......................................................
  11.      
  12.      CITY: ..........................................................
  13.      
  14.      STATE: .................................. ZIP: .................
  15.      
  16.      PHONE: ....................................
  17.      
  18.      Have you EVER ordered a copy of "The Reseller's Source Kit?" .........
  19.                                            (Don't have to)
  20.      
  21.                                 One REGISTERED copy of RESALE94.ZIP  $2.00
  22.      
  23.                        California orders PLEASE add your sales tax  ........
  24.      
  25.                                               SHIPPING POSTAGE PAID ...n/a..
  26.      
  27.                        Specify: (3.5 72K) disk or (5.25 360K) disk: ........
  28.      
  29.      
  30.       Make check or money order out to: DISK-COUNT DATA
  31.      
  32.                           Disk-Count Data
  33.                           P.O. Box 277482
  34.                           Sacramento, CA. 95827-7482
  35.                           916-381-2851 24-HR BBS
  36.