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Text File  |  1997-10-29  |  1.4 KB  |  41 lines
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  4.                      FastLst Credit Card Registration Form
  5.                              PSL Part number 11471
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  7.                    *****************************************
  8.                    * DO NOT SEND this form to the author ! *
  9.                    *****************************************
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  11.               Please read carefully Register.Doc for instructions.
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  14.                                           Date _________________________
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  17.         Cardholder's name, exactly as it appears on the credit card:
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  19.                    _____________________________________________________
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  21.         [Company:] _____________________________________________________
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  24.         Billing address for the card:
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  26.              ___________________________________________________________
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  28.              ___________________________________________________________
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  30.              ___________________________________________________________
  31.         
  32.         Payment by:   ( ) MasterCard          ( ) Visa
  33.                       ( ) American Express    ( ) Discover Card
  34.         
  35.         Card #:  _______________________________  Exp. Date:  __________
  36.         
  37.         Signature of cardholder: _______________________________________
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