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Text File  |  1995-04-30  |  1KB  |  45 lines
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  6.                       SqPrv Credit Card Registration Form
  7.                       PSL Part number 11473
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  10.                   * DO NOT SEND this form to the author ! *
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  13.         Please read carefully Register.Doc for instructions.
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  16.                                           Date _________________________
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  19.   Cardholder's name, exactly as it appears on the credit card:
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  21.              ___________________________________________________________
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  23.   [Company:] ___________________________________________________________
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  26.   Billing address for the card:
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  28.              ___________________________________________________________
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  30.              ___________________________________________________________
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  32.              ___________________________________________________________
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  34.     Payment by:   ( ) MasterCard          ( ) Visa
  35.                   ( ) American Express    ( ) Discover Card
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  37.     Card #:  ________________________________  Exp. Date:  _____________
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  39.     Signature of cardholder: ___________________________________________
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