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REGISTER.FRM
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Text File
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1992-06-26
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2KB
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59 lines
Registration
_________________________________________________________________
Qty Item US Price
___ Registration only ........................ @ $5 ea
$________
(includes user name on ProScribe screen)
___ Registration & Future Upgrades ........... @ $15 ea
$________
(includes user name on ProScribe screen &
next 3 updates sent through mail)
Please Specify: _____ 5¼" disk OR
_____ 3½" disk
TOTAL
$________
Remit To: Brett Nyborg
9238 S. Heather Dr.
Tempe, AZ 85284
Name
_____________________________________________________________
Name to be displayed as registered to (Max 58 characters):
_________________________________________________________________
_
Company
_________________________________________________________
or BBS
Address
_________________________________________________________
_________________________________________________________
_________________________________________________________
Payment by: ___ Check (U.S. bank or branch) ___ Money Order
Work Phone (____) _____________ Home Phone (____)
______________
Signature
________________________________________________________