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Text File  |  1994-06-21  |  2KB  |  59 lines
  1.  
  2.  
  3.  
  4.  
  5.         Registration form for UZBlank from UZful Software
  6.         ----------------------------------------------------------------------
  7.  
  8.         Send to:
  9.                 UZful Software, Inc.
  10.                 PO Box 2089
  11.                 Merrimack, NH 03054-2089
  12.                 USA
  13.  
  14.  
  15.         Individual Registered Version      Qty ____ @ $5.00       $_________
  16.  
  17.  
  18.                                                           Total   $_________
  19.  
  20.  
  21.         Payment method: (  ) Check/money order  (  ) PO # ____________________
  22.         Note: All payments must be in U.S. funds, drawn on a U.S. bank.
  23.  
  24.  
  25.         ______________________________________________________________________
  26.         Name      Last                          First
  27.  
  28.         ______________________________________________________________________
  29.         Title                                   Company Name
  30.  
  31.         ______________________________________________________________________
  32.         Street Address                          City
  33.  
  34.         ______________________________________________________________________
  35.         State/Province/Region                   ZIP/Postal code
  36.  
  37.         ______________________________________________________________________
  38.         Country                                 E-mail address
  39.  
  40.         Where did you get your copy of the program? __________________________
  41.  
  42.  
  43.         What brand and model of laptop do you use? ___________________________
  44.  
  45.         Please give us any feedback (comments, problems, wishes) below.
  46.         Thank you.
  47.  
  48.  
  49.         ______________________________________________________________________
  50.  
  51.  
  52.         ______________________________________________________________________
  53.  
  54.  
  55.         ______________________________________________________________________
  56.  
  57.  
  58.         ______________________________________________________________________
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