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Text File  |  1993-12-23  |  1KB  |  54 lines
  1.  ____________________________________________________________________________
  2.  
  3.     PLEASE FILL THIS OUT (READABLE) AND SEND IT TO ONE OF THESE ADRESSES
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  5.                    P.Schnitzler                    J.Herrmann
  6.                   Heintgesweg 57       oder     Lorenz-Görtz-Str.23
  7.               D-4050 Mönchengladbach 2       D-4050 Mönchengaldbach 2
  8.  
  9.                                    G E R M A N Y
  10.  ____________________________________________________________________________
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  15.                       B R E A K I N - REGISTRATION
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  20.  [ ]  BREAKIN............................. $15 (foreign countries)
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  22.             Shipping & Handling (INCL.)
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  25.              Total enclosed __________
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  28.   IMPORTANT! Circle disk size:  5.25  OR  3.5
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  30.   CPU: 286  386  486
  31.  
  32.   Is this your first order from ASG?   YES   NO
  33.  
  34.           Name: _______________________________________________
  35.  
  36.        Address: _______________________________________________
  37.  
  38.   City, ST Zip: ___________________________________ Phone: _________________
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  40.  
  41.   Payment by: [ ] Money order
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  46.             .............       ........................
  47.                 Date                   Signature
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  49.  ___________________________________________________________________________
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  51.                         THE ACIDMAN OF SCORE GROUP
  52.  ___________________________________________________________________________
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