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REGISTER.DOC
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1992-05-01
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3KB
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64 lines
REGISTRATION FORM
───────────────────────────────────────────────────────────────────
Registration Fee $15.00 $ ____________
Shipping & Handling $ 2.50 $ ____________
---------------
Total $ ____________
I wish to pay by
[__] Check (US Funds / US Bank) - Made payable and sent to Peiman
& Associates, Inc., P.O. Box 948219, Maitland, Florida, 32794.
[__] Credit Card - Fill in the credit card information below.
We will either send the registered version or you can download it along
with your registration key file from, The DOOR BBS, (Tm) & Information
Network at 407-682-3132, (3-Nodes, USR DS/V.32bis/HST).
Please Check the Appropriate box:
[__] I wish my copy sent via US Mail. Pick one of the
following medias ( ___ 5.25" ___ 3.5" )
[__] I wish to download my copy.
Complete ALL of the following information:
Sysop Name: _____________________________________________
Board Name: _____________________________________________
address: _____________________________________________
_____________________________________________
City: _____________________________________________
State: ___________ ZIP: ___________ Phone: ___________________
(For Downloads Only)
Username: ___________________________________________
Password: ___________________________________________
(For Credit Card Purchases)
Name : _____________________________________________________________
(as it appears on your credit card)
Type of Card : ___ Mastercard ___ Visa ___ Diner's Club
___ Carte Blanche
Exp Date : ______ Issuing Bank : ________________________________
Signature : ________________________________________________________
Send to: Peiman & Associates, Inc.
629 Peachwood Drive
Altamonte Springs, FL. 32714