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REGISTER.FRM
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Text File
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1991-08-15
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3KB
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61 lines
╔═════════════════════════════════════════════╗
║ ASSEMBLY LANGUAGE TOOLBOX REGISTRATION FORM ║
╚═════════════════════════════════════════════╝
Remit To: CPC Consulting Company
──────── 1217 Crescent Drive
Smithfield, Va. 23430
(804) 357-9190 Voice / FAX
(804) 357-0357 Club PC BBS
┌┐
└┘ Toolbox Registration Fee is $47.50 U.S. Dollars: $________
┌────────────────────────────────────────────────────┐
│ NOTE: You must get the exchange rate converted │
│ ════ before sending the payment _or_ include the │
│ difference when making payment and I will │
│ get the rate converted to US Dollars for you.│
└────────────────────────────────────────────────────┘
Shipping and Handling Fees: $__N/C__
Virginia Residents add 4.5% Sales Tax ($2.14): $_______
┌┐ ┌┐ ┌┐ ┌┐
Payment by: └┘ Check └┘ Money Order └┘ VISA └┘ M/C TOTAL: $________
┌───────────────────────────────────────────────────────────┐
│ NOTE: If payment is made by Postal Money Orders - They │
│ ════ MUST bear the U.S. Currency ($) symbol or they will │
│ be returned. I can not cash out of USA Money Orders │
│ without this marking !! This is the fastest method │
│ for payment (other than Credit Card!) │
│ │
│ Personal Checks are accepted but MUST be cleared │
│ prior to Shipment (Approx. 10-12 Days! Delay) │
└───────────────────────────────────────────────────────────┘
┌┐ ┌┐ ┌┐ ┌┐
Disk type: └┘360K └┘720K └┘1.2M └┘1.44M
ToolBox Type: ┌┐ ┌┐
└┘Quick Basic └┘Microsoft Prof. Dev. Sys (PDS)
Ship To:
Name: ____________________________________________________
Company: ____________________________________________________
Address1: ____________________________________________________
Address2: ____________________________________________________
City,State,Zip: ____________________________________________________
Phone: _________________________ [Voice] [FAX] (Circle One)
(Note: We do not ship to P.O. Boxes !)
Credit Card Information: (if applicable)
Name as it appears on Card: _____________________________________
Card Number:____________________________________Exp. Date:_______
Signature Req'd! : ______________________________________________
[ NOTE: This form may be FAXED direct for the fastest service! ]
Any Comments?: ______________________________________________________
____________________________________________________________
Where was software obtained from: ___________________________________
Want to DownLoad your REGISTERED copy for EXPRESS DELIVERY ? [Yes] / [No]
If YES, What is your Club PC BBS PASSWORD ? _____________________
If a NEWUSER to Club PC BBS, What PASSWORD do you wish ? ___________________
Thank-You For Registering!