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/ CD Shareware Magazine 1996 December / CD_shareware_12-96.iso / DOS / Programa / CHKZIP10.ZIP / ORDER.FRM < prev   
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Text File  |  1996-10-11  |  1.2 KB  |  43 lines
  1. Official Order form for CHKZIP
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  9. NAME____________________________________________________
  10.                First           Middle             Last
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  12. ADDRESS_________________________________________________
  13.                           Street Address
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  16. CITY_______________      STATE______       ZIPCODE___________
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  19. EMAIL ADDRESS_____________________________________
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  23. TYPE OF COMPUTER YOU OWN___________________________________
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  26. HOW OLD IS THE COMPUTER?____________________________________
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  30. REGISTRATION PRICE $5.00
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  32. please include a check or money order in the amount of $5.00
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  34. make out to:
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  37. John D Saucier (A.K.A) Grim Reaper
  38. 52 Boylston st.
  39. fitchburg,Ma 01420 
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