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Text File  |  1992-11-21  |  3KB  |  60 lines
  1. v2.1                               Apply-Diz
  2.                              Registration Order Form
  3. ===============================================================================
  4.  
  5. First name:____________________         Date:_______________________
  6.  
  7. Last:__________________________         Payment method: *CHECK  MONEY ORDER
  8.                                                             (circle one)
  9. Voice Phone:___________________               
  10.                                         Check or MO #:______________
  11. Data Phone:____________________         *Personal checks may have up to a 10
  12.                                          day delay before clearing.
  13. Address to mail registration to:
  14.                                          QTY
  15. ____________________________________    [   ] Non-Commercial X $10  ________ 
  16.                                         
  17. ____________________________________    [   ] Commercial     X $20  ________
  18.  
  19. ____________________________________    [   ] Disk of latest   
  20.                                               software release X $3 ________ 
  21. ____________________________________          
  22.                                             5.25" or 3.5"      
  23.                                             (circle one)
  24. Please make all checks in                   
  25. U.S. funds payable to:                               Sub Total  =   ________
  26.  
  27.      TOM CARROLL               WA state residents add 7.8% tax  =   ________
  28.  
  29.                                                    Grand Total  =   ________
  30.                                                  (U.S. Funds Only)
  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: (a hard copy letter will be sent in any event)
  35.  
  36. FIRST NAME:_______________________________  LAST NAME:__________________________
  37.  
  38. CITY/STATE:_______________________________  PASSWORD:___________________________
  39.  
  40. DISCLAIMER:  I agree to hold Tom Carroll and Dataware Software harmless of any
  41. damages that may result from the use of Apply-Diz, except for the refund of
  42. the software registration fee should this utility be incompatible with my
  43. computer system.  If a refund is made I agree to destroy all copies of the
  44. registered version of Apply-Diz and registration number(s), and I further
  45. agree to keep my registration serial number confidential and not disclose it
  46. to anyone else in that it may prevent shareware authors from developing cost
  47. effective utilities in the future.
  48.  
  49. SIGNED:_____________________________________________________ DATE:______________
  50.  
  51. Mail to:
  52.            Dataware Software
  53.            1922 W. 4th Avenue
  54.            Kennewick, WA 99336
  55.  
  56. FOR OFFICE USE ONLY:
  57.  
  58. Date received:____________   Amount:______________  Date Mailed:_____________
  59.                                     ______________              _____________
  60.