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SITELIC.FRM
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1991-03-31
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6KB
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78 lines
dCOM Site-License Request Form
┌──────────────────────────────────────────────────────────────────────┐
│ Make checks payable to: Page 1 of 2 │
│ │
│ DAC Micro Systems │
│ 40941 176th St E │
│ Lancaster, CA 93535 │
│ Voice: 805/264-1700 │
│ Data: 805/264-1219 │
│ │
│ 5 to 9 copy license ___ x $29.00 each $_____ │
│ 10 to 49 copy license ___ x $25.00 each $_____ │
│ 50 to 99 copy license ___ x $21.00 each $_____ │
│ 100+ copy license ___ x $19.00 each $_____ │
│ │
│ Subtotal $_____ │
│ │
│ California residents please add 7.0% sales tax. $_____ │
│ │
│ Shipping and handling - inside the United States $4.00 │
│ - or - │
│ - overseas $6.00 │
│ │
│ Credit Card orders add 3% surcharge $_____ │
│ │
│ Total $_____ │
│ │
│ Diskette type (check or circle one): [ ] 5.25" [ ] 3.5" │
│ │
│ Processor type (check or circle one): [ ] IBM [ ] Z100 │
│ │
│ Checks & Money Orders must be drawn on US banks in US funds │
│ │
│ Payment (check or circle one): │
│ │
│ [ ] Check [ ] Money Order [ ] Visa [ ] MasterCard │
│ │
│ Credit Card #___________________________________________ │
│ │
│ Expiration Date _______ Signature _____________________ │
│ │
│ Credit Card Orders may be placed by phone: 805/264-1700 │
│ │
└──────────────────────────────────────────────────────────────────────┘
dCOM Version ____ Site License Form
┌──────────────────────────────────────────────────────────────────────┐
│ Page 2 of 2 │
│ │
│ Name_______________________________________________________ │
│ │
│ Company_______________________________________________________ │
│ │
│ Address_______________________________________________________ │
│ │
│ _______________________________________________________ │
│ │
│ Phone_________________________ Bus.________________________ │
│ │
│ Where did you obtain dCOM? │
│ │
│ _______________________________________________________ │
│ │
│ Comments_______________________________________________________ │
│ │
│ _______________________________________________________ │
│ │
│ _______________________________________________________ │
│ │
│ _______________________________________________________ │
│ │
│ _______________________________________________________ │
│ │
│ _______________________________________________________ │
│ │
│ │
└──────────────────────────────────────────────────────────────────────┘