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Text File  |  1996-01-27  |  5KB  |  59 lines
  1.  ==============================================================================
  2.  |                   Simple Pleasures 1.13 Registration Form                  |
  3.  |============================================================================|
  4.  |                                                                            |
  5.  |       Your Name: _________________________________________________________ |
  6.  | Mailing Address: _________________________________________________________ |
  7.  |                  _________________________________________________________ |
  8.  |                  _________________________________________________________ |
  9.  |                  _________________________________________________________ |
  10.  |    Phone Number: ________________________ FAX: ___________________________ |
  11.  |  E-Mail Address: _________________________________________________________ |
  12.  |                                                                            |
  13.  |  Comments: _______________________________________________________________ |
  14.  |            _______________________________________________________________ |
  15.  |            _______________________________________________________________ |
  16.  |                                                                            |
  17.  |----------------------------------------------------------------------------|
  18.  | Name Of Game                                           Price               |
  19.  |----------------------------------------------------------------------------|
  20.  | Simple Pleasures .................................... $15.00 ..... _______ |
  21.  | Solitaire Suite ..................................... $15.00 ..... _______ |
  22.  | Pyramid Deluxe ...................................... $15.00 ..... _______ |
  23.  | Four Seasons for Windows ............................ $10.00 ..... _______ |
  24.  |----------------------------------------------------------------------------|
  25.  | Discount Schedule (Games Ordered: $Discount)    |       Sub Total: _______ |
  26.  |    2 Games: $5    3 Games: $10    4 Games: $15  |  Minus Discount -_______ |
  27.  |----------------------------------------------------------------------------|
  28.  | Shipping & Handling (Free in North America, $5.00 Otherwise) ..... _______ |
  29.  |----------------------------------------------------------------------------|
  30.  |                                                     Total Payment: _______ |
  31.  |----------------------------------------------------------------------------|
  32.  |                                                                            |
  33.  | Method Of Payment:  ___ Cash         ___ Check (#_____)   ___ Money Order  |
  34.  |                     ___ Mastercard   ___ VISA             ___ Discover     |
  35.  |                                                                            |
  36.  |  Credit Card Info:  Account Number: ______________________________________ |
  37.  |                    Expiration Date: ____ / ____                            |
  38.  |       Exact Name Appearing On Card: ______________________________________ |
  39.  |                          Signature: ______________________________________ |
  40.  |                                                                            |
  41.  |----------------------------------------------------------------------------|
  42.  |                                                                            |
  43.  |    Mail This Form To: Randy Rasa                (cash, check, money order  |
  44.  |                       18215 Troost                         or credit card) |
  45.  |                       Olathe, KS 66062-9208                                |
  46.  |                                                                            |
  47.  |     FAX This Form To: 816-746-9991              (credit card orders only!) |
  48.  |                                                                            |
  49.  |  E-Mail This Form To: rasa.software@dden.com    (credit card orders only!) |
  50.  |                                                                            |
  51.  |----------------------------------------------------------------------------|
  52.  |Prices and terms are subject to change without notice.  Orders that do not  |
  53.  |include all relevant information cannot be processed.  Orders will be proc- |
  54.  |essed within two weeks of receipt of order.  Checks must be drawn on a U.S. |
  55.  |bank, and payable in U.S. funds.  Credit card charges will appear on your   |
  56.  |statement as "D.O.C.S." If no disk size is specified, 1.44M will be assumed.|
  57.  ==============================================================================
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