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1992-10-17
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WinMod Version 1.0 Registration
Please fill out this form, then (e)mail/fax it to
CARECOM(R)
Norbert Unterberg
Gustav-Vorsteher-Strasse 14
D-5802 Wetter/Ruhr 1
Germany
CompuServe: 100112,2740
Fax: ++49-2335-3821
Name: ___________________________________________________________________
Title: __________________________________________________________________
Company: ________________________________________________________________
Address: ________________________________________________________________
________________________________________________________________
City: _____________________________________ State: ________ Zip:______
Country: ___________________________________________
Telephone: _________________________________________
E-mail: ____________________________________________
Comments and Suggestions: _______________________________________________
_________________________________________________________________________
_________________________________________________________________________
Please charge my credit card [__] Eurocard [__] Mastercard [__] Visa
Card Number: _______________________________ Expiration date: __________
Cardholder: ________________________________ Amount (US-$): ____________
(The registration fee is
US-$15 per license)
Date: _______________ Signature: _______________________________________
Thanks for your support!