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Escape! (2.1)
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TEXT_1128_Credit Card Order form.txt
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1996-06-18
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1KB
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48 lines
Product: Escape! 2.1
____________________________________________________________________
Name:
[1]
[2]
[3]
Phone/FAX: [4] [5]
Email: [6]
Comments: [7]
Payment Method:
[8]
[9]
[10]
[11]
Signature (when sending via standard mail):___________________________________
Price per copy................: $10.00
Number of copies............: [12]
Quantity Discount...........: [13]
Send Latest?...(adds $5): [14]
Disk Size (800k or HD): [15]
Sales Tax (CA Only).......: [16]
Note: Sales Tax is only
collected if you've requested
a disk and you live in
California
Total Due.........................: [17]
[18]
____________________________________________________________________
FAX, send via standard mail or email this registration form to:
John V. Holder Email addresses (AOL is preferred):
1734 "S" Street America Online: JohnHolder
Eureka, CA 95501 Internet...........: JohnHolder@aol.com
USA CompuServe....: 75040,1126
Home Page: http://www.northcoast.com/~jvholder
(check for the latest new releases and updates!)
FAX: (707) 443-3813