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Text File  |  1993-12-05  |  2KB  |  64 lines
  1. Registration Form
  2.  
  3. EMAIL ADDRESS:___________________________________________
  4.  
  5. NAME:____________________________________________________
  6. ADDRESS:_________________________________________________
  7.     _________________________________________________
  8.     _________________________________________________
  9. CITY:________________________ STATE:____ ZIP:____________
  10. COUNTRY:____________
  11.  
  12. PHONE # (Data):  ___ ____ ______________
  13.     (Voice): ___ ____ ______________
  14.  
  15. General info:
  16.  
  17. Machine type:  8088/6[_]  80286[_]  80386[_]  80486[_]  Other[_] 
  18. Machine name: ________________________________________
  19.  
  20. Display type:  MDA[_]  CGA[_]  Herc[_]  EGA[_]  MCGA[_]  VGA[_]  SVGA[_]
  21. Card name:_____________________________________________
  22.  
  23. Floppy drives:    3½ 720k[_]  3½ 1.44M[_]  3½ 2.88M[_]
  24.           5¼ 360k[_]  5¼ 1.2M [_]
  25.  
  26.  
  27. Modem speed: 1200[_]  2400[_]  4800[_]  9600[_] 19200[_] Other: ________
  28. Modem name:_____________________________
  29.  
  30. Other configuration:_________________________________________________
  31.             _________________________________________________
  32.             _________________________________________________
  33.             _________________________________________________
  34.             _________________________________________________
  35.  
  36. Driver type:    Svga 32768   ____    @ $20
  37.         Svga 65536   ____    @ $20
  38.         Svga 256     ____    @ $20
  39.         Svga 16      ____    @ $20
  40.         Tweak 256    ____    @ $20
  41.         Tweak 16     ____    @ $20
  42.         Svga S3      ____    @ $20
  43.  
  44.         Two drivers  ____    @ $30 (check above)
  45.         Three          ____    @ $40
  46.         Four         ____    @ $50
  47.         Five drivers ____    @ $60
  48.         Six drivers  ____    @ $70
  49.         Seven drivers____    @ $80
  50.  
  51. Do you want a copy of the source? _____
  52.  
  53. As of July 1, 1993, please send checks/money to:
  54.     Jordan Hargrave
  55.     11701 Metric Blvd, Apt #1726
  56.     Austin, TX 78758
  57.     (512) 834-8164 voice
  58.  
  59. I can accept US currency in cash, checks or money orders.  Sorry, I can't
  60. accept credit cards.
  61.  
  62. If you can only send foreign currency, there is an additional fee of
  63. US $15 (my bank charges for foreign transactions)
  64.