home
***
CD-ROM
|
disk
|
FTP
|
other
***
search
/
The World of Computer Software
/
World_Of_Computer_Software-02-387-Vol-3of3.iso
/
c
/
ccd110.zip
/
REGCCD.FRM
< prev
Wrap
Text File
|
1993-01-25
|
2KB
|
61 lines
CARECOM(R) CCD Version 1.1 Registration
Please fill out this form, then (e)mail/fax it to
CARECOM(R)
Dipl.-Inform. Harald Muehlhoff
Gustav-Vorsteher-Strasse 14
D-5802 Wetter/Ruhr 1
Germany
CompuServe: 100112,2466
Fax: ++49-2335-3821
Please type or use block letters.
Name: ___________________________________________________________________
Title: __________________________________________________________________
Company: ________________________________________________________________
Address: ________________________________________________________________
________________________________________________________________
City: _____________________________________ State: ________ Zip:______
Country: __________________________________ Phone: ____________________
[__] Please send me my key via CompuServe-Mail (ID: ___________________)
Comments and Suggestions: _______________________________________________
_________________________________________________________________________
The software shall be registered to _____________________________________
(only required, if name differs from above Name field)
[__] I include a eurocheque (for account only) for DM 25 made payable
to CARECOM. (Sorry, but other cheques CANNOT be accepted)
[__] I have transferred DM 25 to your bank account # 6 260 087
at the Sparkasse Wetter/Ruhr (Bank Sorting Code Number 452 514 80),
Germany (SWIFT: WELADEDD //BL45251480)
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!