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Text File  |  1992-11-30  |  2KB  |  66 lines
  1.            S Q U A L I D   R E G I S T R A T I O N   F O R M
  2.            =================================================
  3.  
  4.           Registering Squalid is entirely optional, but your
  5.           registration will help to guarantee ongoing support
  6.           and development. Registered users are promised
  7.           responses to netmail enquiries, by crash mail if at
  8.           all practicable, and will be invited to participate
  9.           in beta testing of any enhanced versions that may
  10.           appear from time to time.
  11.  
  12.           Name________________________________________________
  13.  
  14.           Company Name________________________________________
  15.  
  16.           Address_____________________________________________
  17.  
  18.              _____________________________________________
  19.  
  20.           City________________________________________________
  21.  
  22.           State ____  Postcode/Zipcode _______________________
  23.  
  24.           Country if outside Australia________________________
  25.  
  26.           Phone (____)______________ Fax (____)_______________
  27.  
  28.           FidoNet Address __:_____/_____
  29.                   ┌──┐      ┌──┐
  30.           Squalid for DOS │  │ OS/2 │  │ @ $20.00 ea. = $_____
  31.                   └──┘      └──┘
  32.  
  33.           International CrashMail Support
  34.                      ┌──┐
  35.             New Zealand: │  │ @ $5.00         = $_____
  36.                      └──┘
  37.                      ┌──┐
  38.             Elsewhere:   │  │ @ $10.00        = $_____
  39.                      └──┘
  40.           Payment type (tick one):
  41.                                    ┌──┐
  42.               Cheque or Bank Draft in Australian Funds │  │
  43.                                    └──┘
  44.               ┌──┐                 ┌──┐            ┌──┐
  45.          Bankcard │  │      Mastercard │  │       Visa │  │
  46.           (Australia) └──┘                 └──┘            └──┘
  47.  
  48.           Card Number:
  49.           ┌──┬──┬──┬──┐ ┌──┬──┬──┬──┐ ┌──┬──┬──┬──┐ ┌──┬──┬──┬──┐
  50.           │  │  │  │  │ │  │  │  │  │ │  │  │  │  │ │  │  │  │  │
  51.           └──┴──┴──┴──┘ └──┴──┴──┴──┘ └──┴──┴──┴──┘ └──┴──┴──┴──┘
  52.  
  53.           Name on card_________________________________________
  54.  
  55.           Expiry Date ____/____  Signature_____________________
  56.  
  57.  
  58.  
  59.                  Send completed form to:
  60.  
  61.  
  62.                    Greg Newton
  63.                  160 Beaconsfield Parade
  64.                  NORTHCOTE  3070
  65.                     AUSTRALIA
  66.