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Text File  |  1996-12-08  |  2KB  |  49 lines
  1. Software Registration Form             Purchase Order     
  2.                                              Date:________
  3. ____________________________________________________________________
  4. Name:
  5. [1]
  6. [2]
  7. [3]
  8. Phone/FAX:   [4]       [5]
  9.  
  10. Email:   [6]
  11.  
  12. Comments:   [7]  
  13.  
  14. Payment Method..........:   [8]
  15. Purchase Order #.......:   [9][10][11]
  16.  
  17. Products Ordered:
  18. ([12]) TakeABreak 2.0 ($10 each).................:   [13]
  19. ([14]) QuickScrap ($15 each)........................:   [15]
  20. ([16]) ScrapIt Pro ($20 each).......................:   [17]
  21. ([18]) QuickScrap & ScrapIt Pro ($30 each):   [19]
  22. ([20]) QuickPop ($10 each)...........................:   [21]
  23. ([22]) ViewFont ($5 each)..............................:   [23]
  24. ([24]) ColorFall ($10 each)...........................:   [25]
  25. ([26]) Escape! ($10 each)..............................:   [27]
  26. ([28]) SideMinder ($10 each)........................:   [29]
  27.  
  28. Quantity Discount...........:   [30]
  29. Send Latest?...(adds $5):   [31]
  30. Disk Size (800k or HD):   [32]
  31. Sales Tax (CA Only).......:   [33]
  32. Note: Sales Tax is only collected if you've requested a disk and you live in California
  33.  
  34. Total Due.........................:   [34]
  35.  
  36. [35]
  37. ____________________________________________________________________
  38. Please send this form to:
  39.  
  40. John V. Holder                                                           Email addresses (AOL is preferred):
  41. 1734 "S" Street                                                         America Online:  JohnHolder
  42. Eureka, CA  95501                                                   Internet...........:  JohnHolder@aol.com
  43. USA                                                                            CompuServe....:  75040,1126
  44.  
  45. FAX:  (707) 443-3813
  46.  
  47. Home Page:   http://www.northcoast.com/~jvholder
  48. (check for the latest new releases and updates!)
  49.