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Text File  |  1992-01-24  |  1KB  |  55 lines
  1.                      VISUALIB (c) Registration Form
  2.  
  3.        
  4. Visual Tech
  5.  
  6. P.O. Box  8735
  7.  
  8. Fort Wayne, IN 46898-8735
  9.  
  10. (219)489-0235
  11.  
  12. ________________________________________________________________________
  13.  
  14. Product                 Quantity        Unit Price      Amount        
  15.  
  16. Visualib for Windows    ______          $50.00        $ ______
  17.   (Microsoft C version)
  18.  
  19. Visualib for Windows    ______          $50.00          $ ______
  20.   (Borland C++ version)
  21.  
  22. Visualib for DOS        ______          $40.00          $ ______
  23.   (Microsoft C version)
  24.  
  25. Visualib for DOS        ______          $40.00          $ ______
  26.   (Borland C++ version)                 
  27.  
  28.                                                Subtotal $ ______
  29.  
  30.  
  31.              Indiana Residents must add 5.0 % sales tax $ ______
  32.  
  33.  
  34.                                                Shipping $ 5.00
  35.  
  36.  
  37.                                                   TOTAL $ ______
  38.  
  39. Disk Format : ( )5.25"   ( )3.5"
  40.  
  41. ________________________________________________________________________
  42.  
  43.  
  44. Name : __________________________________________________________
  45.  
  46. Company : _______________________________________________________
  47.  
  48. Address : _______________________________________________________
  49.  
  50.           _______________________________________________________
  51.        
  52. City : _______________________ State : _______ Zip : ____________          
  53.        
  54.  
  55.