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Text File  |  1992-10-15  |  3KB  |  65 lines
  1.                                    Apply-Diz
  2.                              Registration Order Form
  3.  
  4. ===============================================================================
  5.  
  6. First name:____________________               Date:_______________________
  7.  
  8. Last:__________________________               Payment method:  CK   MO
  9.                                                              (circle one)
  10. Voice Phone:___________________               
  11.                                               Check or MO #:______________
  12. Data Phone:____________________
  13.  
  14. Address to mail registration to:         QTY
  15.  
  16. Addr-1:_____________________________    [   ] Non-Commercial X $10  ________ 
  17.                                         
  18. Addr-2:_____________________________    [   ] Commercial     X $20  ________
  19.  
  20. Addr-3:_____________________________    [   ] Disk of latest   
  21.                                               software release X $3 ________ 
  22. Addr-4:_____________________________          
  23.                                             5.25" or 3.5"      
  24.                                             (circle one)
  25. Please make all checks payable to           
  26. TOM CARROLL                                          Sub Total  =   ________
  27.  
  28.                                WA state residents add 7.8% tax  =   ________
  29.  
  30.                                                    Grand Total  =   ________
  31.  
  32. If you would like to call my BBS and receive your registration serial number
  33. via a private message, please indicate the below info so I may pre-register
  34. you on my system:
  35.  
  36. FIRST NAME:_______________________________  LAST NAME:__________________________
  37.  
  38. CITY/STATE:_______________________________  PASSWORD:___________________________
  39.  
  40. DISCLAIMER:
  41.  
  42. I agree to hold Tom Carroll and Dataware Software harmless of any damages that
  43. may be caused by Apply-Diz, in which all that he is liable for is the cost to
  44. replace the registration fee, which at that time I will destroy all copies of
  45. the registered version of Apply-Diz and registration number(s).  I further agree
  46. to keep my registration serial number confidential and not disclose it to anyone
  47. else in that it may prevent shareware authors from developing cost effective
  48. utilities in the future.
  49.  
  50.  
  51. SIGNED:_____________________________________________________ DATE:______________
  52.  
  53.  
  54. Mail to:
  55.  
  56.            Dataware Software
  57.            1922 W. 4th Avenue
  58.            Kennewick, WA 99336
  59.  
  60. Thank you...
  61.  
  62.  
  63.  
  64. Date received:______________   Amount:__________  Date Sent:_______________
  65.