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Text File  |  1994-05-25  |  3KB  |  86 lines
  1.  
  2. TicToss Registration Form
  3.  
  4. TicToss's Registration is $10 US funds.
  5.  
  6. Please complete your registration information and return to WER Development by
  7. one of the following choices:
  8.  
  9. - Postal Mail
  10.  
  11. - Electronic Mail
  12.  
  13.         Fidonet:  WerDev@Fidonet#1:136/1
  14.        Internet:  WerDev@Aol.Com
  15.  
  16. - Fax:  318-387-1805
  17.  
  18. ------------------------------------------------------------------------------
  19.  
  20. Information given below is for the internal use of WER Development and will
  21. NOT be shared with other parties -- We respect your privacy!
  22.  
  23.  
  24. Name:    ___________________________________________________________________
  25.  
  26. Address: ___________________________________________________________________
  27.  
  28.          ___________________________________________________________________
  29.  
  30.          ___________________________________________________________________
  31.  
  32. Payment Method:   [ ] Check/Money Order payable to WER Development
  33.  
  34.                   [ ] Visa/Mastercard
  35.  
  36. ------------------------For Credit Card Use Only--------------------------------
  37. |                                                                              |
  38. | Card #  _____________________________________________  Expires _____________ |
  39. |                                                                              |
  40. | Name of Cardholder  ________________________________________________________ |
  41. |                                                                              |
  42. --------------------------------------------------------------------------------
  43.  
  44. BBS Software & Version:  ___________________________   # of Nodes: _________
  45.  
  46. Operating System: _________________________________
  47.  
  48. Operating Environment: _____________________________
  49.  
  50. Would you be interested in a version for:  [ ] OS/2
  51.                                            [ ] __________
  52.  
  53. Comments: ___________________________________________________________________
  54.  
  55.           ___________________________________________________________________
  56.  
  57.           ___________________________________________________________________
  58.  
  59.  
  60. -----------------------------  "Instant Mailer"  ------------------------------
  61. Fold at the page break below with the printing facing out.  Then fold into
  62. a letter style to hide your registration information, but not the mailer info.
  63. Be sure to staple the check to the mailer, then staple or tape sides/top.
  64.  
  65.  
  66.  
  67.  
  68.  
  69. _________________________________                                     Place
  70.  
  71. _________________________________                                     Stamp
  72.  
  73. _________________________________                                     Here
  74.  
  75.  
  76.  
  77.  
  78.  
  79.  
  80.                                          WER Development
  81.                                          500 Roselawn, Suite 4
  82.                                          Monroe, LA 71201  U.S.A.
  83.  
  84. TicToss v1.00
  85.  
  86.