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Text File  |  1994-11-30  |  2KB  |  58 lines
  1.                           ===================
  2.                           CoreSoft Order Form
  3.                           ===================
  4.  
  5.    Name:__________________________________________________________
  6.  
  7. Address:__________________________________________________________
  8.  
  9.    City:_________________________  State/Prov:_____   ZIP:________
  10.  
  11.  
  12. Country:_________________________       Phone:____________________
  13.  
  14.  
  15.  
  16.   MEDIA: [ ] 3.5" 1.44M     [ ] 5.25" 1.2M     [ ] 3.5"  720K
  17.  
  18. PAYMENT: [ ] Check/Money Order (US Funds, Payable to "CoreSoft")
  19.          [ ] COD (US Only, additional charges apply - see below)
  20.          [ ] VISA/MasterCard
  21.                       Card #  ____________________________
  22.  
  23.              Expiration Date  _____ / ______
  24.  
  25.                    Signature  ____________________________
  26.  
  27.  
  28. CHARGES: IMMORAL CUMBAT                          $     15.69
  29.  
  30.          Shipping ($3.95 - USA, $8.95 COD)       $ ______.__
  31.                   ($7.95 - International)
  32.  
  33.          Tax (KS residents only, $1.16 = 5.9%)   $ ______.__
  34.  
  35.          ________________________________________
  36.  
  37.          TOTAL                                   $ ______.__
  38.  
  39.  
  40. I certify that I am at least 18 years of age and am knowingly
  41. purchasing material of an adult nature.
  42.  
  43. SIGNATURE REQUIRED: _________________________________________
  44.  
  45.  
  46. Where did you get the shareware version (please include the
  47. phone # of BBS's)?  _________________________________________
  48.  
  49. _____________________________________________________________
  50.  
  51. _____________________________________________________________
  52.  
  53.  
  54. =============================================================
  55. Mail to:  CoreSoft                   Ordering: (800) 391-7582
  56.           1004 2nd Avenue                      (913) 651-3201
  57.           Leavenworth, KS   66048   Tech Sprt: (913) 651-3201
  58. =============================================================