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Text File  |  1993-11-13  |  2KB  |  63 lines
  1.                          BlackJack! Registration Form
  2.  
  3.     Telephone Orders (314) 458-2863 (Evenings - Central Time)
  4.  
  5.     MAIL TO:  DONALD L. GRANGER
  6.               GLENCOE COMPUTING
  7.               1100 Highway C
  8.               Glencoe, Missouri
  9.                   63038-1404
  10.  
  11.  
  12.     NAME:   ______________________________________     DATE: ___/___/___
  13.  
  14.     ADDRESS:______________________________________
  15.  
  16.     CITY:   ______________________________________
  17.  
  18.     STATE:  ______________  ZIP: _________-_______  COUNTRY: _____________
  19.  
  20.     PHONE:  (____)____-________(in case there's a question about your order)
  21.  
  22.     ___ Registration with documentation on diskette $29.99
  23.            (HP, Epson, & Plain formatting)
  24.     ___ Registration with professionally printed documentation $37.50
  25.     ___ Registration with commented source code & printed documentation $99.99
  26.         (BlackJack! is written in C and Assembler).
  27.  
  28.     International (except Canada) orders please add $3.50 for AIR shipping.
  29.        Be sure to make payment in US funds ($) payable through a US bank.
  30.  
  31.     Where did you obtain your copy of BlackJack! ?: _______________________
  32.  
  33.     YOUR HARDWARE:
  34.  
  35.     Computer _______________  Video adapter ______________ Fixed disk? ____
  36.  
  37.     Diskette size desired:     5 1/4" floppy:_____     3 1/2" micro:_____
  38.     +----------------------------------------------------------------------+
  39.     |                   MASTERCARD AND VISA ARE WELCOME!                   |
  40.     |                                                                      |
  41.     |   Act #_______________________________________   Ex Date ____/____   |
  42.     |                                                                      |
  43.     |   Signature required for credit cards ____________________________   |
  44.     +----------------------------------------------------------------------+
  45.  
  46.     AMOUNT ENCLOSED: $____________
  47.  
  48.     COMMENTS:
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  56.     ------------------------------------+----------------------------------
  57.     Your support is greatly appreciated.|    * * * DO NOT MARK HERE * * *
  58.                                         | Serial # _______________________
  59.     Donald Granger                      | Version  _______________________
  60.                              2.41d 9311 | Ship date_______________________
  61.     ------------------------------------+----------------------------------
  62.                       Please allow 1-2 weeks delivery time                 
  63.