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Text File  |  1995-07-06  |  4KB  |  54 lines
  1. ┌──────────────────────────────────────────────────────────────────────┐
  2. │                                                                      │
  3. │ Return to:     Pik A Program Inc     WORD FUGUE V3.1 REGISTRATION    │
  4. │                13 Saint Marks Place                                  │
  5. │                New York, NY  10003                                   │
  6. │                USA                                                   │
  7. │                                                                      │
  8. │ Name ______________________________________________________________  │
  9. │                                                                      │
  10. │ Company ___________________________________________________________  │
  11. │                                                                      │
  12. │ Address ___________________________________________________________  │
  13. │                                                                      │
  14. │         ___________________________________________________________  │
  15. │                                                                      │
  16. │ Phone _____________________________________________________________  │
  17. │                                                                      │
  18. │                                                                      │
  19. │ Diskette size:     ____ 5.25" acceptable       ____ 3.5" required    │
  20. │                                                                      │
  21. │                    [ ] High density           Quantity   Price       │
  22. │                                                                      │
  23. │ Word Fugue V3.1                ($39/copy):    ________   __________  │
  24. │ (including manual & disks & one large dictionary,                    │
  25. │  special version for 386/486, document templates)                    │
  26. │ Word Fugue V3.1 disks only     ($27/set ):    ________   __________  │
  27. │ Word Fugue manual only         ($20/copy):    ________   __________  │
  28. │ Additional Dictionary          ($10/copy):    ________   __________  │
  29. │ [ ]Australian   [ ]American   [ ]British                             │
  30. │ Subtotal                                                 __________  │
  31. │                                                                      │
  32. │ Shipping charges, per copy:                   ________   __________  │
  33. │                            Postage                                   │
  34. │        Registration      USA          International                  │
  35. │        ------------      ---          -------------                  │
  36. │ Disks Only      $27       $4                 $8                      │
  37. │ Manual Only     $20       $6                $12                      │
  38. │ Disks & Manual  $39       $6                $12                      │
  39. │                                                                      │
  40. │ Total enclosed:                                          __________  │
  41. │                                                                      │
  42. │ I wish to pay by:                                                    │
  43. │     [ ]   Visacard                     [ ]   Check                   │
  44. │     [ ]   Mastercard                                                 │
  45. │     [ ]   Discover                     [ ]   American Express        │
  46. │                                                                      │
  47. │Credit Card:  __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __   │
  48. │                                                                      │
  49. │ Expiry Date:  ___/___ Name: _________________________________________│
  50. │                                                                      │
  51. │                                                                      │
  52. │ Signature :                                                          │
  53. └──────────────────────────────────────────────────────────────────────┘
  54.