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Text File  |  1997-10-06  |  2.1 KB  |  52 lines
  1.                    REGISTRATION/ORDER FORM
  2.  
  3. To: ARK ANGLES             Phone:            ++61-2-4758-8100
  4.     PO Box 190             Fax:              ++61-2-4758-8638
  5.     Hazelbrook 2779        E-mail:   arkangles@compuserve.com
  6.     AUSTRALIA              Web site: www.pnc.com.au/~arkangle
  7.  
  8. Name    _____________________________________________________
  9.  
  10. Company _____________________________________________________
  11.  
  12. Address _____________________________________________________
  13.  
  14.         _____________________________________________________
  15.  
  16.         _____________________________________________________
  17.  
  18. Country _____________________________________________________
  19.  
  20. Phone   __________________________  Fax _____________________
  21.  
  22. E-mail  _____________________________________________________
  23.  
  24. Where software seen or obtained _____________________________
  25.  
  26. Disk Drives:       [ ]3.5"         [ ]5.25"         [ ]CD-ROM
  27.  
  28. Windows Version# ___________   Other OS Version# ____________
  29.  _______________________________________ _______ ___________
  30. | P R O D U C T  /  L I C E N S E       | Q T Y | P R I C E |
  31. |_______________________________________|_______|___________|
  32. |                                       |       |           |
  33. |_______________________________________|_______|___________|
  34. |                                       |       |           |
  35. |_______________________________________|_______|___________|
  36. |                                       |       |           |
  37. |_______________________________________|_______|___________|
  38. |                                       |       |           |
  39. |_______________________________________|_______|___________|
  40. | T O T A L                                     |           |
  41. |_______________________________________________|___________|
  42.  
  43. [ ]AmEx   [ ]Bankcard   [ ]Diners    [ ]Mastercard    [ ]Visa
  44.  
  45. Credit Card No  _______________________   Expiry Date ___/___
  46.  
  47. Cardholder Name _____________________________________________
  48.  
  49. Signature       ___________________________   Date __________
  50.  
  51. Comments:
  52.