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Text File  |  1996-06-19  |  2KB  |  49 lines
  1.  
  2.  
  3. ¬†Registration 
  4. Form
  5.  
  6.  
  7.  
  8. Mail or fax registration form to: 
  9.  
  10. ELS, Inc.¬†
  11. 2622 NW 43rd Street, Suite B4                                                       
  12. Gainesville, Florida 32606
  13.  
  14. Fax: (352) 375-5679           Info: (352) 375-0558           Order: (800) 443-7971
  15. E-mail: elstech@elsinc.com           WWW: http://www.elsinc.com/~elstech
  16.  
  17. Please register me for:
  18.  
  19.     ______ChatNet Personal Edition    ..........................$25
  20.     ______ChatNet 10 User License    ..........................$99
  21.     ______ChatNet 50 User License    ........................$249
  22.     ______ChatNet 250 User License    ......................$499
  23.  
  24. Order Total:  $_____________      (Florida residents add 6% sales tax)
  25.  
  26. Registration Name (Encoded into ChatNet) :    ____________________________________
  27.  
  28. User Name :______________________________________________________________
  29.  
  30. Address: ________________________________________________________________
  31.     
  32. City:    _________________________State: __________      Zip:    _______________________
  33.  
  34. Country:_____________________     Daytime Phone: (_____    )    ________________________
  35.  
  36. Fax Number: (____    )    ________________ E-mail Address: ___________________________
  37.  
  38. Method of Payment:
  39.     _____Check or Money Order (US funds) enclosed payable to: ELS, Inc.
  40.     _____Charge my credit card:   MasterCard _______     VISA ________    
  41.  
  42. Card Number:_____________________________________     Exp. Date: ______________    
  43.  
  44. Name on Card:    ___________________________________________________________
  45.  
  46. Cardholder Signature (required):    ______________________________________________
  47.  
  48. Please send my registration information via:  ___mail   ___fax  ___e-mail.
  49.