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Text File  |  1993-12-24  |  2KB  |  58 lines
  1.  ____________________________________________________________________________
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  3.       PLEASE FILL THIS OUT (READABLE) AND SEND IT TO ONE THESE ADRESSES
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  5.                    P.Schnitzler                    J.Herrmann
  6.                   Heintgesweg 57       oder     Lorenz-Görtz-Str.23
  7.               D-41239 Mönchengladbach        D-41238 Mönchengladbach
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  9.                                    G E R M A N Y
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  11.    BLZ 310 500 00 AccountNr. 5121027  SSK Moenchengladbach Joachim Herrmann
  12.  ____________________________________________________________________________
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  17.                       B R E A K I N - REGISTRATION
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  22.  [ ]  BREAKIN............................. $15 (foreign countries)
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  24.             Shipping & Handling (INCL.)
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  27.              Total enclosed __________
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  30.   IMPORTANT! Circle disk size:  5.25  OR  3.5
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  32.   CPU: 286  386  486
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  34.   Is this your first order from ASG?   YES   NO
  35.  
  36.           Name: _______________________________________________
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  38.        Address: _______________________________________________
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  40.   City, ST Zip: ___________________________________ Phone: _________________
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  43.   Where did you get Breakin ? ________________________________________
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  45.   Payment by: [ ] Money order
  46.               [ ] Money inclosed
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  50.             .............       ........................
  51.                 Date                   Signature
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  53.  ___________________________________________________________________________
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  55.                         THE ACIDMAN OF SCORE GROUP
  56.  ___________________________________________________________________________
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