home *** CD-ROM | disk | FTP | other *** search
/ Computer Buyer 1998 May / dpcb0598.iso / Internet / Autobot / order.frm < prev    next >
Text File  |  1997-04-23  |  2KB  |  44 lines
  1.     Auto-Bot for Win95 v1.0                         Registration Form
  2.     -----------------------------------------------------------------
  3.       Make checks payable to:
  4.          STARBASE-21
  5.          2040 Spring Creek Parkway
  6.          Suite 141-254
  7.          Plano, TX  75023-4225
  8.     -----------------------------------------------------------------
  9.     Qty
  10.     ___ Auto-Bot for Win95 (No Manual/Disk) @ $29.95 each     $______
  11.     ___ Manual/Disk Set                     @ $10.00 each     $______
  12.                                                                 Subtotal     $______
  13.          Texas residents please add 8.25% sales tax.           $______
  14.  
  15.                                                                       Total   $______
  16.  
  17.       Payment: (check or circle one):
  18.       [ ] Check  [ ] Money Order
  19.  
  20.     Checks and Money Orders must be drawn on U.S. banks in U.S. funds
  21.     -----------------------------------------------------------------
  22.  
  23.             Name_______________________________________________________
  24.  
  25.         Company_______________________________________________________
  26.  
  27.         Address_______________________________________________________
  28.  
  29.                  ______________________________________________________
  30.  
  31.           Phone_________________________  Bus.________________________
  32.  
  33.      Where did you obtain Auto-Bot?
  34.  
  35.                  _______________________________________________________
  36.  
  37.       Comments_______________________________________________________
  38.  
  39.                  _______________________________________________________
  40.  
  41.                  _______________________________________________________
  42.  
  43.     -----------------------------------------------------------------
  44.