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Text File  |  1992-02-12  |  2.7 KB  |  58 lines
  1.  
  2.                        ================================
  3.                         ROBOCOMM 4.0 REGISTRATION FORM
  4.                        ================================
  5.  
  6.                         Remit to:    Parsons Consulting
  7.                                      5020 S. Lake Shore Drive
  8.                                      Suite 3301
  9.                                      Chicago, IL  60615-3249
  10.                                      U.S.A.
  11.  
  12.          ------------------------------------------------------------------
  13.          | Item                          | Quantity |  Price |    Total   |
  14.          |-------------------------------|----------|--------|------------|
  15.          | Robocomm version 4.0          | ________ | $40.00 | __________ |
  16.          |                               |          |        |            |
  17.          | Printed Documentation         | ________ | $10.00 | __________ |
  18.          |                               |          |        |            |
  19.          | IL resident's sales tax       |          |   8%   | __________ |
  20.          |                               |          |        |            |
  21.          | Shipping (Outside of U.S.)    | ________ |  $5.00 | __________ |
  22.          |---------------------------------------------------|------------|
  23.          |                                                   |            |
  24.          |   Total amount enclosed                           | __________ |
  25.          ------------------------------------------------------------------
  26.  
  27.          Check desired disk format:    ( ) 5.25" OK      ( ) 3.5" Required
  28.                       Disk Density:    ( ) Low Required  ( ) High OK
  29.  
  30.          Payment by:  ( ) Check or money order (U.S. funds only)
  31.                       ( ) MasterCard
  32.                       ( ) Visa
  33.                       ( ) PO # ______________
  34.  
  35.          Card #: ____________________________________  Exp. Date: _________
  36.  
  37.  
  38.      Signature of card holder: ____________________________________________
  39.  
  40.  
  41.          Name:     ________________________________________________________
  42.  
  43.          Company:  ________________________________________________________
  44.  
  45.          Address:  ________________________________________________________
  46.  
  47.                    ________________________________________________________
  48.  
  49.                    ________________________________________________________
  50.  
  51.          Phone:    ________________________________________________________
  52.  
  53.         FLASH:  INSTANT GRATIFICATION REGISTRATION ONLINE AT GROUP ONE BBS!
  54.                 Call Group One BBS and register with MasterCard or Visa and
  55.                 receive your personalized ROBOUSR.DEF file immediately!
  56.                                 >>>> 312-752-1258 <<<<
  57.  
  58.