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Text File  |  1994-09-26  |  2KB  |  52 lines
  1.            Kitchen Assistant Registration Order Form
  2.  
  3. Today's Date:     _________________
  4.  
  5. Name: _____________________________________________________________
  6.  
  7. Company (if applicable):     __________________________________________
  8.  
  9. Address:     __________________________________________________________
  10.  
  11.          __________________________________________________________ 
  12.  
  13. City: ____________________________ State: ___   Zip code: __________
  14.  
  15. Country: _________________________
  16.  
  17. Email address:     ____________________________________________________
  18.          
  19. ===================================================================
  20.                        Registration Information
  21. Registration Name (if other than name above)
  22.  
  23.           __________________________________          
  24.  
  25. Version being registered: ________________                          
  26.  
  27. ====================================================================
  28.  
  29. Registration Only          $20.00        _____
  30.  
  31. Registration and diskette  $28.00        _____   
  32.  
  33. Diskette only              $10.00        _____
  34.  
  35.                          TOTAL           _____
  36.  
  37. US & Canada Shipping included in above prices.
  38.  
  39. Enclosed: ____ Check  ____ Money Order
  40.  
  41. Authorized Signature: ___________________________    Date: _________    
  42.  
  43.  
  44. Send form with Check or Money Order ( Sorry no credit cards) to:
  45.  
  46.                               Allan Nancoz
  47.                            349 Quincy Avenue
  48.                           Bronx, NY 10465-3011
  49.  
  50.                  Internet Address: anancoz@interport.net
  51.  
  52.