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  1. +------------------------------------------------------------------------+
  2. |                    4A Launch 1.00 Registration Form                    |
  3. +------------------------------------------------------------------------+
  4. |                                                                        |
  5. | NAME:_________________________________________________________________ |
  6. |                                                                        |
  7. | COMPANY:______________________________________________________________ |
  8. |                                                                        |
  9. | ADDRESS:______________________________________________________________ |
  10. |                                                                        |
  11. | CITY:______________________________ STATE:_______ ZIP:________________ |
  12. |                                                                        |
  13. | HOME PHONE NUMBER:____________________________________________________ |
  14. |                                                                        |
  15. | BUSINESS PHONE NUMBER:__________________ FAX NUMBER:__________________ |
  16. |                                                                        |
  17. +------------------------------------------------------------------------+
  18. |                                                                        |
  19. | NUMBER OF USERS                                         PRICE PER USER |
  20. | -----------------------------------------------------   -------------- |
  21. | 1 User Individual License                                   $15.00     |
  22. | 2 To 10 User Network Or Site License                        $14.25     |
  23. | 11 To 25 User Network Or Site License                       $13.50     |
  24. | 26 To 100 User Network Or Site License                      $12.00     |
  25. | 101 Or More User Network Or Site License                    $11.25     |
  26. |                                                                        |
  27. |                                                                        |
  28. |           NUMBER OF USERS MULTIPLIED BY THE PRICE PER USER: $ ________ |
  29. |                                                                        |
  30. |                           NY STATE RESIDENTS ADD SALES TAX: $ ________ |
  31. |                                                                        |
  32. |                                                                        |
  33. |                                                GRAND TOTAL: $ ________ |
  34. |                                                                        |
  35. +------------------------------------------------------------------------+
  36. |       TO REGISTER THIS PROGRAM, MAIL YOUR PAYMENT & THIS FORM TO:      |
  37. |                              4A Software                               |
  38. |                           562 Buxton Avenue                            |
  39. |                     West Hempstead, New York 11552                     |
  40. |  *** Please make all checks or money orders out to DAVID M. BISHOP *** |
  41. +------------------------------------------------------------------------+
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  67. +------------------------------------------------------------------------+
  68. |  If you would like to find out about our other shareware offers, send  |
  69. |  this form to:                                                         |
  70. |                              4A Software                               |
  71. |                           562 Buxton Avenue                            |
  72. |                     West Hempstead, New York 11552                     |
  73. |  *** Please make all checks or money orders out to DAVID M. BISHOP *** |
  74. +------------------------------------------------------------------------+
  75. |                                                                        |
  76. | NAME:_________________________________________________________________ |
  77. |                                                                        |
  78. | COMPANY:______________________________________________________________ |
  79. |                                                                        |
  80. | ADDRESS:______________________________________________________________ |
  81. |                                                                        |
  82. | CITY:______________________________ STATE:_______ ZIP:________________ |
  83. |                                                                        |
  84. | HOME PHONE NUMBER:____________________________________________________ |
  85. |                                                                        |
  86. | BUSINESS PHONE NUMBER:__________________ FAX NUMBER:__________________ |
  87. |                                                                        |
  88. +------------------------------------------------------------------------+
  89. |                                                                        |
  90. |                                                       SINGLE USER      |
  91. | ITEM                              AVAILABLE   QUANTITY   PRICE*  TOTAL |
  92. | -------------------------------   ---------   --------   -----   ----- |
  93. |                                                                        |
  94. | PRODUCT INFORMATION PACKAGE          NOW      ________    FREE   _____ |
  95. |                                                                        |
  96. | West Hempstead Country Club          NOW      ________    FREE   _____ |
  97. |                                                                        |
  98. | Malverne Country Club                NOW      ________    FREE   _____ |
  99. |                                                                        |
  100. | Scribble 1.00                        NOW      ________    FREE   _____ |
  101. |                                                                        |
  102. | 4A Calc 3.00                         NOW      ________  $ 5.00   _____ |
  103. |                                                                        |
  104. | 4A Draw 2.00                         NOW      ________  $ 5.00   _____ |
  105. |                                                                        |
  106. | 4A Draw Upgrade From Scribble        NOW      ________  $ 2.50   _____ |
  107. |                                                                        |
  108. | Universal Lottery Picker 1.00        NOW      ________  $ 7.50   _____ |
  109. |                                                                        |
  110. | 4A Launch 1.00                       NOW      ________  $15.00   _____ |
  111. |                                                                        |
  112. | 4A Basketball 2.70                  01/93     ________  $12.50   _____ |
  113. |                                                                        |
  114. |                                                                        |
  115. |                                                TOTAL PRICE: $ ________ |
  116. |                                                                        |
  117. |                           NY STATE RESIDENTS ADD SALES TAX: $ ________ |
  118. |                                                                        |
  119. |                                        SHIPPING & HANDLING: $ ________ |
  120. |   ($2.50 IN USA, $5.00 IN NORTH AMERICA, $10.00 ELSEWHERE)             |
  121. |                                                                        |
  122. |                                                GRAND TOTAL: $ ________ |
  123. |                                                                        |
  124. +------------------------------------------------------------------------+
  125. | * The prices listed under SINGLE USER PRICE are for a single user      |
  126. |   individual license.  Please write for multi-user site license prices.|
  127. +------------------------------------------------------------------------+
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