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Text File  |  1996-06-20  |  2.4 KB  |  46 lines

  1.  [Registration Form]                                               [06/19/96]
  2.  ____________________________________________________________________________
  3.  
  4.  Please enter following EXACTLY as appears in your MAKEWILD config, this info
  5.  is used in your registration key.  Please type or print legibly.
  6.       
  7.   BBS Name     : [___________________________]  WC! Reg#: [_____________]
  8.  
  9.   Real Name    : [______________________________________________________]
  10.  
  11.   Address      : [______________________________________________________]
  12.  
  13.   City/ST/Zip  : [______________________________________________________]
  14.  
  15.   Voice Number : [_________________]   BBS Number   : [_________________]
  16.  
  17.   Receive codes:  [ ] Internet Email: [_________________________________]
  18.                   [ ] Snail Mail (United States Postal Service)
  19.                   [ ] My BBS:  Alter Ego BBS
  20.                                [205.586.0555]  Password: [______________]
  21.  ____________________________________________________________________________
  22.  [Wildcat v5.x Products]                      | [For Office Use Only]
  23.                                               |
  24.   [ ] CheckSec           $10.00  $ __________ | [___________________________]
  25.                                               |
  26.   [ ] opPAGE5            $ 8.00  $ __________ | [___________________________]
  27.                                               |
  28.   [ ] __________________ (other) $ __________ | [___________________________]
  29.                                               |
  30.   [ ] __________________ (other) $ __________ | [___________________________]
  31.                                               |
  32.   [ ] __________________ (other) $ __________ | [___________________________]
  33.                                               |
  34.             (discounts/coupons) -$ __________ | [________]
  35.                                 ============= |
  36.                                               |
  37.                          total:  $ __________ |
  38.                                               |
  39.   Check/Money Order in U.S. Funds only        |
  40.                                               |
  41.   payable to:  [ Corinne King        ]        |  RCD: [_____________]
  42.                [ 481 Parkwood Lane   ]        |
  43.                [ Arab, Alabama 35016 ]        | SENT: [_____________]
  44.  _____________________________________________|______________________________
  45.  
  46.