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REGISTER.FRM
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Wrap
Text File
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1992-03-05
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12KB
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176 lines
┌─────────────────────────────────────────────────────────┐
│ ▓▓▓▓▓ │
│ REGISTRATION ▓▓▓▓▓ │
│ of THE JL's ▓▓▓▓▓ │
│ │
│ Juergen Lorenz │
│ Laufgraben 39 │
│ 2000 Hamburg 13 │
│ Germany │
└─────────────────────────────────────────────────────────┘
┌─────────────────────────────────────────────────────────┐
│ REGISTRATION FORM for JLUTIL, JLPLOT and JLBANK │
│ │
│ GT Net/Node: ___/___ Date: __-__-____ │
│ THE JL's SN: _______ │
│ [ ] AFSN [ ] GTPN [ ] WAP [ ] OTHER [ ] NONE │
│ GT Version: _________ [ ] upgrading GT regulary │
│ │
│ Name: ___________________ BirthDate: __-__-____ │
│ Address: ___________________ │
│ Address: ___________________ │
│ ZIP City: ____________________________________________ │
│ Country: ___________________ │
│ Phone (Voice): _______________ (BBS): _______________ │
│ │
│ Kind of payment: [ ] Cash DM/US$ [ ] CreditCard │
│ [ ] EuroCheque [ ] Money Order │
│ [ ] Remittion │
│ │
│ Kind of currency: [ ] DM [ ] US$ │
└─────────────────────────────────────────────────────────┘
┌──────────────────────────────────┬──────┬──────┬──────┬────────┐
│No Description │ DM │ UK£ │ US$ │SubTotal│
├──────────────────────────────────┼──────┼──────┼──────┼────────┤
│ │ │ │ │ │
│[ ] INITIAL Registration │100.00│ 38.00│ 67.00│________│
│ │ │ │ │ │
│[ ] UPGRADE from a prior version │ 30.00│ 11.50│ 20.00│________│
│ │ │ │ │ │
│[ ] JLUTIL Package #1 │ │ │ │ │
│ (1 Initial & 5 UpGrades) │150.00│ 57.00│100.00│________│
│ │ │ │ │ │
│[ ] JLUTIL Package #2 │ │ │ │ │
│ (5 UpGrades) │ 90.00│ 34.00│ 60.00│________│
│ │ │ │ │ │
│[ ] JLUTIL Package #3 │ │ │ │ │
│ (5 Initial Registrations) │300.00│113.50│200.00│________│
│ │ │ │ │ │
│[ ] SINGLE OPTIONS │ │ │ │ │
│ │ │ │ │ │
│ [ ] AC 1 [ ] DM 2 [ ] ME 0│ │ │ │ │
│ [ ] AN 1 [ ] EX 2 [ ] ML 1│ │ │ │ │
│ [ ] CA 1 [ ] GC 2 [ ] MO 5│ │ │ │ │
│ [ ] CF 1 [ ] HE 1 [ ] MS 1│ │ │ │ │
│ [ ] CH 1 [ ] HU 1 [ ] PD 0│ │ │ │ │
│ [ ] CM 2 [ ] IL 5 [ ] PM 3│ │ │ │ │
│ [ ] CU 2 [ ] IN 1 [ ] PR 1│ │ │ │ │
│ [ ] PL 4 [ ] BA 3 [ ] VM 1│ │ │ │ │
│ [ ] IP 2 [ ] DC 2 [ ] RE 0│ │ │ │ │
│ [ ] SE 0 [ ] ST 1 [ ] SU 1│ │ │ │ │
│ [ ] TE 0 [ ] UP 1 [ ] UT 1│ │ │ │ │
│ [ ] QU 2 │ │ │ │ │
│ ─┬─ ┬─ ┬ │ │ │ │ │
│ │ │ └─ points you need │ │ │ │ │
│ │ └ Name of the option │ │ │ │ │
│ └ Indicate with a cross, │ │ │ │ │
│ that you want it. │ │ │ │ │
│ │ │ │ │ │
│ Points, you need for │ │ │ │ │
│ │ │ │ │ │
│ ■ INITIAL: ________ P. each.│ 5.00│ 2.00│ 3.50│________│
│ │ │ │ │ │
│ ■ UPGRADE: ________ P. each.│ 3.00│ 1.20│ 2.00│________│
│ │ │ │ │ │
│[ ] HANDLING (postage,etc) │ │ │ │ │
│ (otherwise you will receive │ │ │ │ │
│ only the crc. For package #1 │ │ │ │ │
│ you need eg. 6 handlings) │ │ │ │ │
│ for each handling add.│ 30.00│ 11.50│ 20.00│________│
│ │ │ │ │ │
│[ ] If remitting the money add.│ 15.00│ 6.00│ 10.00│________│
│ │ │ │ │ │
│[ ] If paying with EuroCheque add.│ 15.00│ 6.00│ 10.00│________│
│ │ │ │ │ │
│[ ] ... with another cheque add.│ 20.00│ 8.00│ 13.50│________│
│ │ │ │ │ │
│[ ] If paying with CreditCard add.│ 30.00│ 11.50│ 20.00│________│
│ └──────┴──────┴──────┴────────┤
│ TOTAL: │
│ ___________________________ ════════╡
│ Signature │
└────────────────────────────────────────────────────────────────┘
----AFTER READING, YOU CAN KILL THE TEXT YOU DON'T NEED FROM HERE ON-------
Read the following informations, if you want to pay by credit card,
with a cheque eg. an EuroCheque or if you want to remit the money
to my bankaccount.
NOTICE: The best, cheapest and fastest way to pay me is to go to
your bank and remit the money or get a cheque in DM of a
german bank and send this cheque to me via mail.
┌───────────────────────────────────────────────────────────────────────┐
│If paying by CREDIT CARD (Access, Visa, Eurocard and MasterCard) │
│then take notice of the following points: │
│ │
│ ■ we are adding 12.67% to the Total amount for the CreditCard │
│ Company and our additional costs or a minimum of 30.00 DM. │
│ │
│ ■ we are charging your CreditCard in Sterling using a exchanging │
│ rate of (1 DM = 2.65 £). │
│ │
├───────────────────────────────────────────────────────────────────────┤
│If paying by credit card (Access, Visa, Eurocard and MasterCard) │
│then please enter: │
│ │
│■ Name shown on card : │
│■ Address of holder : │
│ : │
│ : │
│ : │
│ : │
│■ Card type : ACCESS - VISA - EC - MC (indicate) │
│■ Card Number : ______ - ______ - ______ - ______ │
│■ Expiry Date : ______ / ______ │
│ │
│Please debit my credit card as above, signed: ________________________ │
└───────────────────────────────────────────────────────────────────────┘
┌───────────────────────────────────────────────────────────────────────┐
│If paying with a CHEQUE, then take notice of the following points: │
│ │
│ ■ you must enter the amount in DM │
│ ■ if your bank is not in Germany, you have to add 5.67% to the │
│ Total amount for our additional costs or a minimum of 20.00 DM. │
└───────────────────────────────────────────────────────────────────────┘
┌───────────────────────────────────────────────────────────────────────┐
│If paying with an EUROCHEQUE, then take notice of the following points:│
│ │
│ ■ you must enter the amount in DM │
│ ■ you must enter the CardNumber at the backside of the cheque │
│ ■ if your bank is not in Germany, you have to add 5.67% to the │
│ Total amount for our additional costs or a minimum of 15.00 DM. │
│ │
├───────────────────────────────────────────────────────────────────────┤
│If paying with EuroCheque, then please enter: │
│ │
│■ Name shown on EuroCheque Card : │
│■ Card Number : __________________________ │
└───────────────────────────────────────────────────────────────────────┘
┌───────────────────────────────────────────────────────────────────────┐
│If you want to REMIT the money to my bankaccount, then take notice of │
│the following points: │
│ │
│ ■ you must enter the amount in DM │
│ ■ you must enter, that you are paying the costs of this remittion. │
│ ■ if your banque is outside of Germany, you have to add 15.00 DM │
│ to the Total amount for our additional costs. │
│ ■ here are my details: │
│ │
│ Name: Juergen Lorenz │
│ Account Number: 75127700 │
│ SortCode: 20110022 │
│ BankName: Postsparkassenamt Hamburg │
│ Location: 2000 Hamburg (Germany) │
└───────────────────────────────────────────────────────────────────────┘
------------AFTER READING, YOU CAN KILL THE TEXT YOU DON'T NEED------------