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- | MIDILANG/PIK A PROGRAM ORDER FORM 1/2 |
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- You may mail, fax, e-mail, or phone in your order. Please send the
- completed registration form, along with payment to Pik A Program, Inc. at:
-
- Pik A Program (tm) TOLL FREE (ORDERS ONLY) 1-800-445-3346
- 13 Saint Marks Place Telephone (212) 598-4459
- NY, NY 10003 USA Fax (212) 228-5879
- USA Compuserve: 74777,3233
- Internet: 74777,3233@CompuServe.COM
-
- __________________________________________________________________________
- (Name)
-
- __________________________________________________________________________
- (Company)
-
- __________________________________________________________________________
- (Street1)
-
- __________________________________________________________________________
- (Street2)
-
- __________________________________________________________________________
- (Town) (State) (Zip)
-
- __________________________________________________________________________
- (Telephone) (Fax) (Country if outside USA)
-
- You will get a diskette containing the latest full version of the
- program. Shipping within North America is $4.00 for your entire order,
- whether you order 1 or 100 items.
-
-
- QUANTITY ITEM PRICE EACH TOTAL
- --------------------------------------------------------------------------
- MidiLang US$ 35.00 US$
- --------------------------------------------------------------------------
- Shipping US$ 4.00 US$ 4.00
- --------------------------------------------------------------------------
- TAX (NYS residents only) ___ % US$
- --------------------------------------------------------------------------
- TOTAL: US$
- ================
- Orders are sent on 3.5" high density diskettes unless otherwise requested.
- -------------------------------------------------------------------------
- | MIDILANG/PIK A PROGRAM ORDER FORM 2/2 |
- -------------------------------------------------------------------------
-
- I am paying by:
- ( ) CHECK ( ) VISACARD ( ) MASTERCARD ( ) AMERICAN EXPRESS
- ( ) CASH (by registered mail only, please) ( ) DISCOVER CARD
-
- Number ______-______-______-______ Exp. date ___-___
-
- ________________________________________________ ______-______-______
- (Signature) (Date)
-
-
-
- THANK YOU FOR REGISTERING YOUR SHAREWARE!
-
- Important: If you are ordering by mail or fax, please completely fill
- out this form and send it in. If you are sending a check or money
- order, please make sure that payment is made in US funds drawn on a US
- bank.
-
-
- For registered users of any program which Pik A Program distributes, who
- do not already have access to Compuserve, we can supply a FREE
- Compuserve membership with a $15.00 usage credit. This is much more
- than enough online time to have your technical support questions
- answered, and still have some fun!
-
- For those who do not have access to a modem, we offer special pay by the
- minute telephone support. This is available to registered and
- non-registered users of our programs, but registered users get a
- discount. Call us for information.
-
-
- We would appreciate it if you would tell us where did you first heard
- about this program. Thanks for your cooperation.
- [] BBS - which one?______________________________________
- [] Friend [] retail store package
- [] CD-ROM - which one?___________________________________
- [] magazine - which one?_________________________________
- [] other - ______________________________________________
-
- For latest shareware copy of MidiLang, use the WEB pages
- of Pik A Program : http://www.pik.com
-
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