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Text File  |  1994-07-07  |  1KB  |  31 lines
  1. ************************************************************
  2.             Control Strip Pack Shareware Registration Form
  3. ************************************************************
  4.  
  5. Name_______________________________________________________
  6.  
  7. Company____________________________________________________
  8.  
  9. Address_____________________________________________________
  10.  
  11. City__________________ State___________________ Zip___________
  12.  
  13. Country______________ Phone (___)____-______ Fax (___)____-______
  14.  
  15. E-Mail_______________________________________
  16. ************************************************************
  17. _____ Copies at US$ 10.00 per copy TOTAL US$  ________ ************************************************************
  18. Method of Payment:
  19.  
  20. ____ Cash
  21.  
  22. ____ Check (US funds only, drawn on a US Bank. 
  23.             Please make checks payable to Men & Mice)
  24.  
  25. ___ Visa ___Mastercard ___Amex #_______________ Exp Date ______
  26. Note: If you pay by Credit Card you will be charged in Icelandic krona and 
  27.       there could be a slight inaccuracy in the dollar amount due to currency 
  28.       fluctuations.
  29.  
  30. Signature_________________________________ Date_____________
  31.