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Text File  |  1994-02-01  |  1.7 KB  |  53 lines
  1. ****************************************************************************
  2.             Monitor Expander Shareware Registration Form
  3. ****************************************************************************
  4.  
  5. Name________________________________________________________________________
  6.  
  7. Company_____________________________________________________________________
  8.  
  9. Address_____________________________________________________________________
  10.  
  11. City____________________________ State_______________________ Zip___________
  12.  
  13. Country___________________ Phone (____)______-______ Fax (____)______-______
  14.  
  15. E-Mail_______________________________________
  16. ****************************************************************************
  17.  
  18. Shareware Fees
  19. --------------
  20. Single Machine            -   US$ 25.00
  21. 2 - 20 Copies             -   US$ 15.00 per copy
  22. Unlimited Site License    -   US$ 350.00
  23.  
  24. Number of Copies  ____  @ ____ Total US$ _________
  25.  
  26. ****************************************************************************
  27. Method of Payment:
  28.  
  29. ____ Cash
  30.  
  31. ____ Check (US funds only.  Please make checks payable to Men & Mice)
  32.  
  33. ____ Visa ____Mastercard ____Amex #_________________________ Exp Date ______
  34. Note: If you pay by Credit Card you will be charged in Icelandic krona and 
  35.       there could be a slight inaccuracy in the dollar amount due to currency 
  36.       fluctuations.
  37.  
  38. Signature_________________________________________ Date_____________________
  39.  
  40. Mail to:
  41. Men & Mice
  42. P.O. Box 7238
  43. 107 Reykjavik
  44. ICELAND
  45.  
  46. Electronic mail to:
  47. me-registrations@rhi.hi.is
  48.  
  49. Phone: +354-169-4596
  50. Fax: +354-169-4991
  51.  
  52.                      *** THANK YOU FOR SUPPORTING SHAREWARE ***
  53.                         Please allow 4-6 weeks for delivery