home *** CD-ROM | disk | FTP | other *** search
/ PC Online 1997 October / PCO1097.ISO / FilesBBS / WIN95 / HD95CP22.ARJ / REG.TXT < prev   
Encoding:
Text File  |  1997-04-24  |  1.1 KB  |  53 lines
  1.                   Order/Registration Form
  2.  
  3.  
  4. To:
  5.  
  6.     Dr. Gottfried Siehs
  7.     Tiergartenstrasse 99
  8.     A-6020 Innsbruck
  9.     Austria / Europe
  10.  
  11.  
  12.  
  13. I / We want to register HD95COPY 2.2
  14.  
  15. Name: _________________________________________________________
  16.  
  17. Company: ______________________________________________________
  18.  
  19. Address: ______________________________________________________
  20.  
  21. Town/City: ____________________________________________________
  22.  
  23. Country: ______________________________________________________
  24.  
  25. Post Code: ______________
  26.  
  27. Phone: __________________  FAX: ______________________
  28.  
  29. E-mail: ______________________________________________
  30.  
  31.  
  32.  
  33.  
  34. User name string for registration (max. 80 characters)
  35.   
  36. _______________________________________________________________
  37.  
  38.  
  39. Number of copies to register: _______
  40.  
  41. Total payment   : ___________________
  42.  
  43. via
  44. ( ) cheque
  45. ( ) sending cash (should only be sent by registered post)
  46. ( ) bank transfer to
  47.     Österreichische Postsparkasse, BLZ 60000
  48.     Kto-Nr 7786.901
  49.     (Dr. Gottfried Siehs)
  50.  
  51.  
  52. Thank you for registering HD95COPY!
  53.