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1991-09-27
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47 lines
DYNAGEN Registration Form
MYNDTRYX
PO Box 1836
Elyria, OH 44036 USA
Phone: (216) 365-9667
FAX: TBA
CompuServe: 73737,1761
Name _____________________________________________ Today's Date ___________
Company ____________________________________________________________________
Title ______________________________________________________________________
Address ____________________________________________________________________
City _________________________ State ______________ ZIP Code _____________
Country __________________ FAX __________________ Phone __________________
Thru 12/1/91 After 12/1/91
# of PCs Copies Times Price/PC/Site Price/PC/Site Amount
-------- ------ ----- ------------- ------------- ---------
1 ______ X $69.00 $79.00 $ _______
2-20 ______ X 64.00 74.00 _______
21-50 ______ X 59.00 69.00 _______
51-100 ______ X 54.00 64.00 _______
100+ ______ X 49.00 59.00 _______
Shipping & Handling (single package)
$3.00 in US & Canada _______
$5.00 outside US & Canada _______
Call MYNDTRYX for bulk orders _______
Subtotal (total $ for DYNAGEN + shipping) $ _______
Ohio residents add 6.0% state sales tax _______
(Subtotal * 1.06)
Grand Total $ _______
* MAKE CHECK PAYABLE TO "MYNDTRYX c/o Peter M. Jagielski" *