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Text File  |  1994-02-14  |  5KB  |  60 lines
  1.  ============================================================================
  2.  |       Registration of FaxMail for Windows and/or FaxMail for DOS         |
  3.  |                                                                          |
  4.  |                            ElectraSoft                 1-713-261-0307    |
  5.  |                       2307 Carmel Valley Drive                           |
  6.  |                      MISSOURI CITY  TX  77459-3068                       |
  7.  |==========================================================================|
  8.  |                                                                          |
  9.  | Date:____/____/____ Country:_______________ Wk Phone:___________________ |
  10.  |                                                                          |
  11.  | Name:______________________________________ Hm Phone:___________________ |
  12.  |                                                                          |
  13.  | Address:___________________________________ Fx Phone:___________________ |
  14.  |                                                             _            |
  15.  | City:________________________ State:____ ZIP:___________________________ |
  16.  |==========================================================================|
  17.  | Disk size (Please check one): []5.25  []3.5                              |
  18.  |-----+--------------------------------------------------------------------|
  19.  | Qty | Item                                                     Amount    |
  20.  |-----+--------------------------------------------------------------------|
  21.  |     |                                                                    |
  22.  |_____| FaxMail for Windows - - - - - - - - - - - - - -  $25.00  $_____.__ |
  23.  |     |                                                                    |
  24.  |_____| FaxMail for DOS - - - - - - - - - - - - - - - -  $25.00  $_____.__ |
  25.  |     |                                                                    |
  26.  |_____| Both FaxMail for DOS and Windows  - - - - - - -  $45.00  $_____.__ |
  27.  |                                                                          |
  28.  | Shipping and handling - - - - - - - - - - - - - - - -   $4.00  $    4.00 |
  29.  |                                                                          |
  30.  | Subtotal  - - - - - - - - - - - - - - - - - - - - - - - - - -  $_____.__ |
  31.  |                                                                          |
  32.  | Texas residents please add Sales Tax (8%) - - - - - - - - - -  $_____.__ |
  33.  |                                                                          |
  34.  | Total (Pay this amount) - - - - - - - - - - - - - - - - - -  US$_____.__ |
  35.  |==========================================================================|
  36.  |                                                                          |
  37.  | Bugs or suggested improvements (print on back side if needed):__________ |
  38.  |                                                                          |
  39.  | ________________________________________________________________________ |
  40.  |                                                                          |
  41.  | Computer Brand:_________________________________________________________ |
  42.  | Processor: []8088  []80286  []80386  []80486  []Other:__________________ |
  43.  | Machine Speed: []25Mhz  []33Mhz  []50Mhz  []66Mhz  []Other:_____________ |
  44.  | Display Type: []MDA  []HGC  []CGA  []MCGA  []EGA  []VGA  []SVGA          |
  45.  |               []Other:_______________                                    |
  46.  | Floppy Drive(s): []3 1/2" 1.4MB  []5 1/4" 1.2MB  []Other:_______________ |
  47.  |                                                                          |
  48.  | Name of HardDrive:__________________________________ size:____________MB |
  49.  |                                                                          |
  50.  | Modem Brand:____________________________________________________________ |
  51.  | Data Speed: []1200bps  []2400bps   []9600bps  []14400bps  []16800bps     |
  52.  | []16800bps  []19200bps []28800bps  []38400bps []Other:______bps          |
  53.  | FAX Speed:  []1200bps  []2400bps   []9600bps  []14400bps  []16800bps     |
  54.  | []19200bps  []28800bps []38400bps  []Other:______bps                     |
  55.  | Supported:  []HST  []V.32  []V.32bis  []V.42bis  []Other:________________|
  56.  |                                                                          |
  57.  | Signature:__________________________________________ Date:______________ |
  58.  ============================================================================
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