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Text File  |  1995-11-17  |  2KB  |  68 lines
  1.  
  2.                            ------------------------
  3.                            Itrack Registration Form
  4.                            ------------------------
  5.  
  6.        Itrack can be registered with this form for users in
  7.        Baltic states (Latvia, Estonia, Lithuania).
  8.  
  9.        If you are a node of FidoNet, SBCNet or ZyXELnet, I
  10.        will send your key(s) via Crash mail directly to you.
  11.  
  12.        If you do not have address in any of these nets, your key will
  13.        be held for pickup on Castle available on the following number:
  14.  
  15.               +371-2-223986 - ZyXEL 19,200 ZyX/V32b/V32/V42b
  16.        2:5100/8@fidonet, 14:3300/100@sbcnet, 16:1700/105@zyxelnet
  17.  
  18.  
  19. Hereby I order a key for Itrack.
  20.  
  21. Name       : ______________________________________________________________
  22. Street     : ______________________________________________________________
  23. City       : ______________________________________________________________
  24. Postalcode : ________
  25. Country    : ______________________________________________________________
  26.  
  27. Net Address: __:____/____.____    [  ] FidoNet  [  ] SBCNet  [  ] ZyXELnet
  28. BBS name   : ______________________________________________________________
  29.              (only if available)
  30.  
  31. Mailer:           _________________________________________________________
  32.  
  33. Hardware:         _________________________________________________________
  34.  
  35.  
  36. ORDER INFORMATION
  37.  
  38. [  ] Key(s) for Itrack (each) Ls 3.5,--                  : Ls ____.__
  39.  
  40. [  ] Send key(s) per disk, add Ls 1.5,-- for handling    : Ls ____.__
  41.  
  42.         [  ] 5.25"      [  ] 3.5"
  43.  
  44.                                                          ------------
  45.                                               Total      : Ls ____.__
  46.                                                          ============
  47.  
  48. Only cash payments are accepted currently.
  49.  
  50. I, __________________, the undersigned,
  51.  
  52. promise that no Itrack Key(s) will be distributed to others and I am to
  53. ensure that my key is not accessible to any other person.
  54.  
  55.                                              Date: __-__-19__
  56.  
  57.                                              Signature:
  58.  
  59.                                              _______________________
  60.  
  61.  
  62.  
  63. Mail this form to:      Egons Bush
  64.                         20 Virzas street
  65.                         Iecava,  District Bauska
  66.                         LV-1339  LATVIA
  67.  
  68.