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- GoMac 1.1 Registration Form
-
- Send this form with payment to: Proteron
- Attn: GoMac Sales
- 9600 East 150 Highway
- Kansas City, MO 64149
-
- Internet registration at http://www.proteron.com/gomac
-
- ====================== Registration Information ======================
-
- <LastName>, <FirstName> <MI>
- <Company>
- <Address1>
- <Address2>
- <City>, <State> <Zip>
- <Country>
- *EMail: <EMail>
-
- ------------------------ Purchase Information ------------------------
-
- Purchase Quantity: <Copies> copies
- <Copies1995> at $19.95
- <Copies0500> at $5.00
-
- Bulk Purchase Price:
- <Copies1495> at $14.95
-
-
- Total cost: <Total>
-
- ------------------------ Payment Information -------------------------
-
- **Payment Method: <Pmt>
-
- Credit Card Information
- Name on Card: <CCName>
- Card Number: <CC#> Exp. Date: <ExpDate>
-
- First Virtual Information
- FV Account: <FV#>
-
- ----------------------------------------------------------------------
- *If you include an email address, you will receive your serial number
- via email within 48 hours after we receive this form.
- **REMEMBER: If paying by Check/Money Order, be sure to include payment.