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Text File  |  1996-08-15  |  2KB  |  62 lines
  1.  
  2.                   SOMEPLACE (WINDOWS 95) REGISTRATION FORM
  3.  
  4.         NAME:     ______________________________________________________
  5.  
  6.         COMPANY:  ______________________________________________________
  7.  
  8.         ADDRESS:  ______________________________________________________
  9.  
  10.                   ______________________________________________________
  11.  
  12.         CITY:     ______________________________________________________
  13.  
  14.         STATE:    ________________________  ZIP CODE:  _________________
  15.  
  16.         PHONE:    ______________________________________________________
  17.  
  18.         E-MAIL ADDRESS:  _______________________________________________
  19.  
  20.         WHERE DID YOU RECEIVE SOMEPLACE? _______________________________
  21.  
  22.         ________________________________________________________________
  23.  
  24.         COMMENTS:  _____________________________________________________
  25.  
  26.         ________________________________________________________________
  27.  
  28.  
  29.         Registration @ $15.00 (includes domestic shipping)   $__________
  30.  
  31.         Package on disk (unnecessary if you can obtain from
  32.         web page http://www.cs.appstate.edu/u/cs/mh/granny)
  33.         @ $3.00                                               __________
  34.  
  35.         Shipping (only if disk is ordered)
  36.         outside U.S./Canada/Mexico @ $1.00                    __________
  37.  
  38.         (Payments MUST be in U.S. Dollars/U.S. Bank, VISA/MC,
  39.         check only for orders under $15.)
  40.  
  41.  
  42.                                                     TOTAL:   $__________
  43.  
  44.         Payment by  ____check  
  45.  
  46.         ____VISA  ____MC  #________________________________Exp_________
  47.  
  48.           Signature____________________________________________________
  49.  
  50.  
  51.  
  52.         Mail to:         
  53.  
  54.                  Granny's Old-Fashioned Software
  55.                         297 Camp Rock Road
  56.                          Boone, NC 28607
  57.  
  58.        or fax to: (704) 264-4634 
  59.        or phone information to (704) 264-6906
  60.  
  61.  
  62.