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Text File  |  1993-11-22  |  2KB  |  63 lines
  1.  
  2.  
  3.  
  4.                             ACIRAN V3.6 REGISTRATION FORM
  5.  
  6.         NAME:     ______________________________________________________
  7.  
  8.         COMPANY:  ______________________________________________________
  9.  
  10.         ADDRESS:  ______________________________________________________
  11.  
  12.                   ______________________________________________________
  13.  
  14.         CITY:     ______________________________________________________
  15.  
  16.         COUNTY:   ________________________  Post Code:  ________________
  17.  
  18.         PHONE:    ______________________________________________________
  19.  
  20.         E-MAIL ADDRESS:  _______________________________________________
  21.  
  22.         WHERE DID YOU RECEIVE Aciran?  _________________________________
  23.  
  24.         ________________________________________________________________
  25.  
  26.         COMMENTS:  _____________________________________________________
  27.  
  28.         ________________________________________________________________
  29.  
  30.  
  31.         Registration @ £45.00                                £__________
  32.  
  33.         Floppy Disk Type, Tick one                      5.25"     _____
  34.  
  35.                                                         3.5"      _____
  36.  
  37.         Shipping outside U.K. @ £1.50                         __________
  38.             (Payments MUST be in Pounds Stering)
  39.  
  40.  
  41.                                                  SUBTOTAL:   £__________
  42.  
  43.  
  44.                                                     TOTAL:   £__________
  45.  
  46.  
  47. Please enclose a check payable to Aciran Software Systems; or you may
  48.  use Access, Visa, MasterCard, or EuroCard.  For credit cards,
  49.  please enter the information below:
  50.  
  51.  Card #:__ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __
  52.  
  53.  Expiration date: ____/____
  54.  
  55.  Signature:  _________________________________________
  56.  
  57.  
  58.         Remit to:         Aciran Software Systems
  59.                           29 DunCryne Place,
  60.                           BishopBriggs,
  61.                           Glasgow
  62.                           Scotland G64 2DP
  63.