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Text File  |  1996-09-01  |  865 b   |  42 lines
  1.  
  2.                       Regalia's Subscription Form
  3.                      =============================
  4.  
  5. The credit cards accepted are: 
  6. American Express Cards, EuroCard, MasterCard, VISA, I.C.C & IsraCard
  7.  
  8. Can be ordered by 
  9.  
  10.   e-mail: danymozs@netvision.net.il 
  11.  
  12. or
  13.  
  14.  Fax: + 972 6 399 304  (24 hours) [usually 00 prefix should be added]
  15.  
  16.  
  17. Please fill in the details:
  18.  
  19. E-MAIL______________________ 
  20.  
  21. FIRST  NAME____________________
  22.  
  23. FAMILY NAME____________________
  24.  
  25. ADDRESS__________________________________
  26.        
  27.        -----------------------------------
  28.  
  29. COUNTRY_________________
  30.  
  31. CREDIT CARD TYPE___________________________
  32.  
  33. CREDIT CARD NUMBER________________________
  34.  
  35. EXPIRATION DATE____________________________
  36.  
  37. SIGNATURE_________________________________
  38.  
  39.  
  40. One Year Subscription (52 weekly e-mail issues) -   $55.00
  41.  
  42.