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Text File  |  1989-04-22  |  2KB  |  57 lines
  1.  
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  4.                JaxHost v4.0 Communications Software Order Form
  5.  
  6.  
  7.                                       Order Date:  _____________________
  8.  
  9.  
  10.         Name:     ______________________________________________________
  11.  
  12.         Company:  ______________________________________________________
  13.  
  14.         Address:  ______________________________________________________
  15.  
  16.                   ______________________________________________________
  17.  
  18.         City:     ______________________________________________________
  19.  
  20.         State:    ________________________  ZIP Code:  _________________
  21.  
  22.         Phone:    ______________________________________________________
  23.  
  24.         Where did you obtain JaxHost? __________________________________
  25.  
  26.         ________________________________________________________________
  27.  
  28.         Comments:  _____________________________________________________
  29.  
  30.         ________________________________________________________________
  31.  
  32.         ________________________________________________________________
  33.  
  34.         Registration Fees:
  35.  
  36.         Number of copies      Cost per Copy              Remittance
  37.  
  38.            _________      x      $20.00        =         $__________
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  40.  
  41.         Diskette, Postage, Handling:
  42.          (No need to fill in amount unless
  43.          ordering an upgrade diskette @ $5.00.)          $__________
  44.  
  45.        (Registration or upgrade diskette order entitles
  46.         user to mail notification of availability of
  47.         next release.)
  48.  
  49.        Payments must be in US dollars.          TOTAL:   $__________
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  53.         Remit to:         J. C. Kilday Associates
  54.                           Central Avenue
  55.                           Peaks Island, ME 04108
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