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Text File  |  1994-08-30  |  4KB  |  56 lines
  1.       ╔═════════════════════════════════════════════════════════════════╗
  2.       ║         DATE-NET  -  APPLICATION AND REGISTRATION FORM          ║
  3.       ║ * * * * * * *        The TRADERS MARKET           * * * * * * * ║
  4.       ║   Voice     *             P.O. Box 138            *     BBS     ║
  5.       ║201-384-1500 *       Oradell, N.J. 07649-0138      * 201-385-5586║
  6.       ╠═════════════════════════════════════════════════════════════════╣
  7.       ║                                                                 ║
  8.       ║  Your Name:  ________________________________________________   ║
  9.       ║                                                                 ║
  10.       ║   BBS Name:  ________________________________________________   ║
  11.       ║                                                                 ║
  12.       ║    Address:  ________________________________________________   ║
  13.       ║                                                                 ║
  14.       ║       City:  ______________________ State: __ Zip: __________   ║
  15.       ║                                                                 ║
  16.       ║  Modem Type:___________________      Modem Speed:____________   ║
  17.       ║  Number of Users:_______                                        ║
  18.       ║  Number of Nodes:_______                                        ║
  19.       ║  Data/BBS                              Other                    ║
  20.       ║  Telephone:  (____) _____ - _________  Networks: _____________  ║
  21.       ║              (____) _____ - _________            _____________  ║
  22.       ║              (____) _____ - _________            _____________  ║
  23.       ║                                                                 ║
  24.       ║  Voice                                 FIDO                     ║
  25.       ║  Telephone:  (____) _____ - _________  Address: _____________   ║
  26.       ║  FAX #    :  (____) _____ - _______                             ║
  27.       ║                                                                 ║
  28.       ║  BBS Program: ______________________  Mailer: _______________   ║
  29.       ║              ┌───────────────────────────────────────────────┐  ║
  30.       ║  Description │                                               │  ║
  31.       ║  of your BBS │                                               │  ║
  32.       ║  or System:  │                                               │  ║
  33.       ║              │                                               │  ║
  34.       ║              │                                               │  ║
  35.       ║              └───────────────────────────────────────────────┘  ║
  36.       ╠═════════════════════════════════════════════════════════════════╣
  37.       ╠═════════════════════════════════════════════════════════════════╣
  38.       ║   I have read the DATE-NET Policy documentation and accept full ║
  39.       ║   responsibility for its contents. (You MUST include a signed   ║
  40.       ║   copy of the DATENET.POL and mail BOTH parts as your app.)     ║
  41.       ║                                                                 ║
  42.       ║   Date: ________      Signature:__________________________      ║
  43.       ║                                                                 ║
  44.       ║   Amount of Application Fee enclosed $____________________      ║
  45.       ╠═════════════════════════════════════════════════════════════════╣
  46.       ║  Recruited by: ___________________________________________      ║
  47.       ║                                                                 ║
  48.       ║  Comments: _______________________________________________      ║
  49.       ║                                                                 ║
  50.       ╚═════════════════════════════════════════════════════════════════╝
  51.                             (Application Fee $10.00)
  52.      Please remit application fee by one of the following methods:
  53.      1) personal or business check
  54.      2) certified funds or money order
  55.      3) Visa, Mastercard or American Express
  56.