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- [Registration Form] [06/19/96]
- ____________________________________________________________________________
-
- Please enter following EXACTLY as appears in your MAKEWILD config, this info
- is used in your registration key. Please type or print legibly.
-
- BBS Name : [___________________________] WC! Reg#: [_____________]
-
- Real Name : [______________________________________________________]
-
- Address : [______________________________________________________]
-
- City/ST/Zip : [______________________________________________________]
-
- Voice Number : [_________________] BBS Number : [_________________]
-
- Receive codes: [ ] Internet Email: [_________________________________]
- [ ] Snail Mail (United States Postal Service)
- [ ] My BBS: Alter Ego BBS
- [205.586.0555] Password: [______________]
- ____________________________________________________________________________
- [Wildcat v5.x Products] | [For Office Use Only]
- |
- [ ] CheckSec $10.00 $ __________ | [___________________________]
- |
- [ ] opPAGE5 $ 8.00 $ __________ | [___________________________]
- |
- [ ] __________________ (other) $ __________ | [___________________________]
- |
- [ ] __________________ (other) $ __________ | [___________________________]
- |
- [ ] __________________ (other) $ __________ | [___________________________]
- |
- (discounts/coupons) -$ __________ | [________]
- ============= |
- |
- total: $ __________ |
- |
- Check/Money Order in U.S. Funds only |
- |
- payable to: [ Corinne King ] | RCD: [_____________]
- [ 481 Parkwood Lane ] |
- [ Arab, Alabama 35016 ] | SENT: [_____________]
- _____________________________________________|______________________________
-
-