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Text File  |  1993-03-17  |  3KB  |  60 lines
  1. v2.6                               Apply-Diz
  2.                              Registration Order Form
  3. ===============================================================================
  4.  
  5. First name:____________________         Date:_______________________
  6.  
  7. Last name:_____________________         Payment method: *CHECK  MONEY ORDER
  8.                                                             (circle one)
  9. Voice Phone:___________________               
  10.                                         Check or MO #:______________
  11. Data Phone:____________________         *Personal checks may have up to a 10
  12.                                          day delay before clearing.
  13. Address to mail registration to:
  14.                                          QTY
  15. ____________________________________    [   ] Non-Commercial X $10  ________ 
  16.                                         
  17. ____________________________________    [   ] Commercial     X $20  ________
  18.  
  19. ____________________________________    [   ] Disk of latest   
  20.                                               software release X $3 ________ 
  21. ____________________________________          
  22.                                             5.25" or 3.5" ( DD or HD )
  23.                                                   (circle one)
  24. Please make all checks in                   
  25. U.S. funds payable to:                               Sub Total  =   ________
  26.  
  27.      TOM CARROLL                                   Grand Total  =   ________
  28.          or                                                 (U.S. Funds Only)
  29.   DATAWARE SOFTWARE
  30.  
  31. If you would like to call my BBS and receive your registration serial number
  32. via a private message, please provide the below info so I may pre-register
  33. you on my system: (a hard copy letter will be sent in any event)
  34.  
  35. FIRST NAME:_______________________________  LAST NAME:__________________________
  36.  
  37. CITY/STATE:_______________________________  PASSWORD:___________________________
  38.  
  39. DISCLAIMER:  I agree to hold Tom Carroll and Dataware Software harmless of any
  40. damages that may result from the use of Apply-Diz, except for the refund of
  41. the software registration fee should this utility be incompatible with my
  42. computer system.  If a refund is made I agree to destroy all copies of the
  43. registered version of Apply-Diz and registration number(s), and I further
  44. agree to keep my registration serial number confidential and not disclose it
  45. to anyone else in that it may prevent shareware authors from developing cost
  46. effective utilities in the future.
  47.  
  48. SIGNED:_____________________________________________________ DATE:______________
  49.  
  50. Mail to:
  51.            Dataware Software
  52.            1922 W. 4th Avenue
  53.            Kennewick, WA 99336
  54.  
  55. FOR OFFICE USE ONLY:
  56.  
  57. Date received:____________   Amount:______________  Date Mailed:_____________
  58.                                     
  59.                                     ______________              _____________
  60.