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REGISTER.FRM
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1992-10-04
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FLAK 1.01 (BBS) - File List & Access by Keyboard - Registration Form
Date: ___________________
Send (and make check/money order payable) to:
Paul J. Dickler
P.O. Box 732
Denville, NJ 07834
From:
Name: __________________________________
(Company:) __________________________________
Street: __________________________________
__________________________________
City: __________________________________
State/Zip: __________________________________
In-use Version:
---------------
Version Number: _________________________
Vendor/Distributor: _________________________
Single user US $25
2 - 10 users US $23 each Count: ______
11 - 20 users US $21 each
21 & up users US $19 each Sub total: _____________
Upgrade Version:
----------------
Single user US $35
2 - 10 users US $33 each Count: ______
11 - 20 users US $31 each
21 & up users US $29 each Sub total: _____________
Diskette format (circle/check one):
5.25" ______ 3.5" ______
Distribution is by single diskette - Count: ______
Extra copies: US $5 each Sub total: _____________
Distribution outside of United States
and Canada: US $5 Sub total: _____________
New Jersey residents -
Add state tax: %6.0 Sub total: _____________
Enclosed Grand total: _____________