home *** CD-ROM | disk | FTP | other *** search
/ ftp.wwiv.com / ftp.wwiv.com.zip / ftp.wwiv.com / pub / DOOR / AB105.ZIP / REGISTER.DOC < prev    next >
Text File  |  1994-06-01  |  2KB  |  55 lines
  1.                                   ARROWBRIDGE V1.05
  2.                                   REGISTRATION FORM
  3.                                   -----------------
  4.                                    (Please Print)
  5.  
  6.  Registered to:___________________________________________ FIDO _:____/____
  7.  (BBS Name)                                                (if applicable)
  8.  
  9.  First Name :____________________ Last Name:_______________________________
  10.  (Sysop Name)
  11.  
  12.  Address:__________________________________________________________________
  13.  
  14.  
  15.  Suburb or City:____________________________ State:____ Postal Code:_______
  16.  
  17.  
  18.  Country:__________________________ Home Phone: (     )____________________
  19.  
  20.  
  21.                     AUSTRALIA                            FOREIGN
  22.                 ~~~~~~~~~~~~~~~~~                    ~~~~~~~~~~~~~~~~
  23.                     $ 25.00                              $ 30.00
  24.  
  25.    CREDIT CARD ORDERS:
  26.  
  27.       Fill out your credit card information and mail this
  28.       form to the address listed below.
  29.  
  30.       Type of Credit Card:   MasterCard    Visa    Bankcard
  31.           (Circle one)
  32.  
  33.       Credit Card Number        : _____________________________________
  34.  
  35.       Expiry Date               : _________
  36.  
  37.       Name as it appears on card: _____________________________________
  38.  
  39.  
  40.       Signature                 : ____________________________
  41.  
  42.  
  43.    CHEQUES & POSTAL ORDERS
  44.  
  45.       All cheques should be made out to Legend Electronics and in
  46.       Australian dollars only.  Postal orders (Australian) will also 
  47.       be accepted.
  48.  
  49. ----------------------------------------------------------------------------
  50.    SEND TO:        Legend Electronics
  51.             PO Box 6
  52.             Brookvale
  53.             NSW  2100
  54.             AUSTRALIA
  55. ----------------------------------------------------------------------------