home *** CD-ROM | disk | FTP | other *** search
/ Cream of the Crop 21 / Cream of the Crop 21 (Terry Blount) (October 1996).iso / bbs / agree10.zip / REGISTER.TXT < prev   
Text File  |  1996-06-19  |  2KB  |  44 lines
  1. --------------------------------------------------------------------------
  2.                        USER AGREEMENT DOOR ORDER FORM
  3. --------------------------------------------------------------------------
  4.  
  5.  REGISTRATION NAME : _______________________________   (AS SHOULD APPEAR IN
  6.                                                         REGISTRATION)
  7.          YOUR NAME : _______________________________   (IF DIFFERENT)
  8.  
  9.     POSTAL ADDRESS : ______________________________________________________
  10.  
  11.                      ______________________________________________________
  12.  
  13.                      ______________________________________________________
  14.  
  15.   E-MAIL ADDRESSES : ____________________________________   (IF APPLICABLE)
  16.  
  17.    ADDITIONAL INFO : ______________________________________________________
  18.                      i.e. Fax Number
  19.  
  20. I WISH TO RECEIVE MY ORDER BY:
  21.           ___
  22.          |   | - INTERNET E-MAIL (FASTEST)
  23.          |___|
  24.           ___
  25.          |   | - CONVENTIONAL MAIL
  26.          |___|
  27.           ___
  28.          |   | - FAX (INCLUDE FAX #)
  29.          |___|
  30.  
  31.                         ___
  32. I WOULD LIKE TO ORDER: |   | - USER AGREEMENT DOOR REGISTRATION KEY
  33.                        |___|   ($5 US DOLLARS)
  34.  
  35. MAKE CHECKS PAYABLE TO:   MIKE PENTA
  36.                            P.O. BOX 67277
  37.                            CUYAHOGA FALLS, OHIO
  38.                            USA
  39. +-- OFFICIAL USE ONLY ----------------------------------------------------+
  40. |                                                                         |
  41. | S.N. : _____________  SENT : _________________________________________  |
  42. +-------------------------------------------------------------------------+
  43.  
  44.