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Action Arcade 1997
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order.txt
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1997-01-01
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2KB
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57 lines
============================================
RODGE ROCK in RETRO ACTIVE REGISTRATION FORM
============================================
YES, I'd like to receive registered copy of
RODGE ROCK in RETRO ACTIVE !
Print this form, fill in the details and
return to us !
NAME:_____________________________________________________
ADDRESS:_____________________________________________________
_____________________________________________________
CITY:________________________ STATE/PROV:_________________
ZIP CODE:____________________ PHONE/FAX:______________________
COUNTRY (if not AUSTRALIA):______________________
Australian orders: $39.95 per copy
U.S. orders: $29.95 (US dollars) per copy
European orders: £19.95 per copy
AUSTRALIAN ORDERS: _____ copies @ $39.95 plus $5.00 P/H ea : _______
U.S. ORDERS: _____ copies @ $29.95 plus $4.00 P/H ea : _______
EUROPEAN ORDERS: _____ copies @ £19.99 plus £3.00 P/H ea : _______
>> TOTAL PAYMENT: _______
DISK TYPE: ( ) 3.5 inch ( ) 5.25 inch
PAYMENT TYPE: ( ) Check ( ) Money Order
( ) Bankcard ( ) Visa ( ) MasterCard
CARD NUMBER:_____________________________________________________
EXPIRATION DATE:_____/_____ SIGNATURE:_________________________
NAME ON CREDIT CARD (if different from above):___________________
Make checks payable to Rodge Rock Software
ORDERS MAIL TO:
Rodge Rock Software
PO Box 682
Scarborough 6019
Western Australia