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Text File  |  1991-10-18  |  1KB  |  61 lines
  1.  
  2.                                    PBH ADDRESS
  3.                                    version 1.0
  4.                    (C) Copyright 1991 by PBH Software Services
  5.                                ALL RIGHTS RESERVED
  6.  
  7.  
  8.  
  9.                                 REGISTRATION FORM
  10.  
  11.  
  12.  
  13.            NAME:  __________________________________________________
  14.  
  15.  
  16.          STREET:  __________________________________________________
  17.  
  18.  
  19.                   __________________________________________________
  20.  
  21.  
  22.            CITY:  __________________________________________________
  23.  
  24.  
  25.             STATE:  _______      ZIP:  ____________  -  _________
  26.  
  27.  
  28.  
  29.                           number of copies in use:  _________
  30.  
  31.                                                  X    10.00  each
  32.  
  33.  
  34.                                        =  payment:  _________
  35.  
  36.  
  37.             NY state residents please
  38.                         add sales tax      +  tax:  _________
  39.  
  40.  
  41.                                  =  total payment:  _________
  42.  
  43.  
  44.  
  45.       Comments:  _______________________________________________________
  46.  
  47.  
  48.       __________________________________________________________________
  49.  
  50.  
  51.       __________________________________________________________________
  52.  
  53.  
  54.       __________________________________________________________________
  55.  
  56.  
  57.  
  58.                  send to:    PBH Software Services
  59.                              4770 Country Club Drive
  60.                              Syracuse, NY  13215
  61.