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CREDIT.EED
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Wrap
Text File
|
1992-11-16
|
2KB
|
34 lines
+---------------------------------------------------------+
| To : Brad Vonarx |
| P.O. Box 801 |
| Croydon 3136 |
| Victoria, AUSTRALIA |
| __ |
| |__| Please send me one Private Registration key |
| for EzyEdit for $25 AUD |
| OR |
| __ |
| |__| Please send me one Commercial Registration key |
| for EzyEdit for $40 AUD |
| |
| Please charge the registration key to my credit card. |
| __ __ __ |
| Card Type : |__| MasterCard |__| Visa |__| Bankcard |
| |
| My Full Card Number is : |
| |
| |
| └─┴─┴─┴─┘ └─┴─┴─┴─┘ └─┴─┴─┴─┘ └─┴─┴─┴─┘ |
| |
| Valid From ___/___/___ Until End ___/___/___ |
| |
| Name on Card : _______________________________________ |
| |
| Address : _______________________________________ |
| |
| ____________________ Post Code : ______ |
| |
| Signature of Cardholder : _____________________________ |
| |
+---------------------------------------------------------+