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Text File  |  1995-08-30  |  1.5 KB  |  63 lines
  1.  
  2. Register MAKHLP 
  3. ---------------
  4.  
  5. NAME:_________________________________________________________________
  6.  
  7. Company:___________________________________________________________________
  8.  
  9. Address:___________________________________________________________________
  10.  
  11. City/state:________________________________________________________________
  12.  
  13. Zipcode:___________________________________________________________________
  14.  
  15. Country:-------------------------------------------------------------------
  16.  
  17. E-Mail:____________________________________________________________________
  18.  
  19. **************************************************************
  20.  
  21. Pricing:
  22.         Normal registration:
  23.                 300F for FRANCE                           (  )
  24.                 350F for other countries 70$
  25.  
  26.         
  27.         Disk Format:    ( )3.5"   ( )5.25"
  28.  
  29.  
  30. Propositions:___________________________________________________
  31.  
  32. ________________________________________________________________
  33.  
  34. ________________________________________________________________
  35.  
  36. ________________________________________________________________
  37.  
  38. ________________________________________________________________
  39.  
  40.  
  41.  
  42.  
  43. Signature:
  44.  
  45.  
  46.  
  47. payment:
  48.               postal money-order
  49.  
  50.  
  51.     VISA INTERNATIONAL:
  52.  
  53.     _ _ _ _ / _ _ _ _ / _ _ _ _ / _ _ _ _  Valid : _ _ / _ _
  54.  
  55.  
  56. ADDRESS:
  57.  
  58.         Company WIN NOVATON INFORMATIQUE
  59.         1107 Avenue Jacques CARTIER
  60.         44811             SAINT HERBLAIN
  61.                          FRANCE
  62.  
  63.