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Text File  |  1996-08-16  |  3KB  |  63 lines
  1.                           ***********************
  2.                           *  REGISTRATION FORM  *
  3. ***************************                     ****************************
  4. *                                                                          *
  5. *                  PROGRAM NAME:   TILEZ CHALLENGE                         *
  6. *                  TARGET CPU/OS:  80286 with standard VGA, DOS 3.0 & up   *
  7. *                  VERSION:        1.0                                     *
  8. *                  AUTHOR:         ROBERT J. TIESS                         *
  9. *                                                                          *
  10. ****************************************************************************
  11.  
  12. ------------------------------->> cut here <<-------------------------------
  13.  
  14.                     "TILEZ CHALLENGE" REGISTRANT DATA
  15.  
  16. * PLEASE PRINT                          TODAY'S DATE ______________________
  17.  
  18.  
  19. LAST NAME ________________________      FIRST NAME ________________________
  20.  
  21.  
  22. ADDRESS LINE 1 ___________________________________
  23.  
  24. ADDRESS LINE 2 ___________________________________
  25.  
  26. ADDRESS LINE 3 ___________________________________   ZIP CODE _____________
  27.  
  28.  
  29. ENCLOSED IS $ 7.00  [  ] CASH (U.S. CURRENCY _ONLY_; NOT RECOMMENDED)
  30.                     [  ] CHECK PAYABLE TO:   Robert J. Tiess
  31.                                              44A Rockwood Gardens
  32.                                              Middletown, NY 10940
  33.           CHECK # _______ CHECK DATE _______
  34.  
  35.  ** Please answer as many of the following questions as fully as possible. **
  36.  
  37.   1.  Where did you acquire TILEZ CHALLENGE?  [ ] BBS  [ ] INTERNET
  38.                                               [ ] FRIEND  [ ] I FORGET ;)
  39.       If BBS was checked, please specify BBS
  40.       name, location,  and phone number, including the area code:
  41.  
  42.       NAME:  ________________________  PHONE NUMBER:  (    ) _______________
  43.  
  44.       LOCATION: _____________________
  45.  
  46.   2.  What operating system do you use:  [ ] PC/MS-DOS, VERSION: ___________
  47.                                          [ ] WINDOWS, VERSION:   ___________
  48.                                          [ ] OTHER, SPECIFY:     ___________
  49.  
  50.   3.  Did you encounter any problems when installing or playing the game?
  51.  
  52.       [ ] NO  [ ] YES:  ____________________________________________________
  53.  
  54.                         ____________________________________________________
  55.  
  56.   4.  Please share with me any comments or suggestions you have:
  57.  
  58.       ______________________________________________________________________
  59.  
  60.       ______________________________________________________________________
  61.  
  62.  * * * * * * * * THANK YOU FOR REGISTERING "TILEZ CHALLENGE" * * * * * * * *
  63.