home *** CD-ROM | disk | FTP | other *** search
/ Cream of the Crop 1 / Cream of the Crop 1.iso / BUSINESS / CLNTKPR.ARJ / DISK2.EXE / CKORDER.FRM next >
Text File  |  1992-07-30  |  3KB  |  64 lines
  1.             Simple Software Solutions, Inc.
  2.             P.O. Box 1505
  3.             Centralia, IL  62801
  4.  
  5.   First Name               MI   Last Name                
  6. ┌─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┐ ┌─┐ ┌─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┐
  7. │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │
  8. └─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┘ └─┘ └─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┘ 
  9.   Address
  10. ┌─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┐
  11. │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │
  12. └─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┘
  13.   c/o
  14. ┌─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┐
  15. │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │
  16. └─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┘
  17.   City                              State     Zip Code
  18. ┌─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┐     ┌─┬─┐    ┌─┬─┬─┬─┬─┬─┬─┬─┬─┬─┐
  19. │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │     │ │ │    │ │ │ │ │ │-│ │ │ │ │
  20. └─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┘     └─┴─┘    └─┴─┴─┴─┴─┴─┴─┴─┴─┴─┘
  21.   Daytime Phone                         Cash      MC     Visa
  22. ┌─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┐                ┌─┐      ┌─┐     ┌─┐
  23. │ │ │ │-│ │ │ │-│ │ │ │ │                │ │      │ │     │ │
  24. └─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┘                └─┘      └─┘     └─┘ 
  25.   Credit Card Number              Exp. Date   Signature
  26. ┌─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┐ ┌─┬─┬─┬─┬─┐
  27. │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │/│ │ │
  28. └─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┘ └─┴─┴─┴─┴─┘ ────────────────────────────────
  29.   Sold Date                  Ship Date               Update Disk Shipped
  30. ┌─┬─┬─┬─┬─┬─┬─┬─┐           ┌─┬─┬─┬─┬─┬─┬─┬─┐          ┌─┬─┬─┬─┬─┬─┬─┬─┐  
  31. │ │ │/│ │ │/│ │ │           │ │ │/│ │ │/│ │ │          │ │ │/│ │ │/│ │ │
  32. └─┴─┴─┴─┴─┴─┴─┴─┘           └─┴─┴─┴─┴─┴─┴─┴─┘          └─┴─┴─┴─┴─┴─┴─┴─┘
  33.  
  34.                                                          Price    Amount
  35.   ┌─┐
  36.   │ │RuKar CLIENT KEEPER PLUS                           $99.95   
  37.   └─┘                                                            ───────── 
  38.      Shipping & Handling                                             7.50
  39.                                                                  ───────── 
  40.      Illinois Residents add 6.25% Sales Tax
  41.                                                                  ───────── 
  42.      TOTAL
  43.                                                                  ═════════
  44.                     ┌─┐              ┌─┐
  45.      Media Type:    │ │ 5 1/4"       │ │ 3 1/2"
  46.                     └─┘              └─┘
  47. Please enter the name (up to 35 characters) you wish to appear on the program.
  48. ┌─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┬─┐
  49. │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │ │
  50. └─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┴─┘
  51. "Must be registered to an individual"
  52.  
  53. Desired Password (up to 10 characters).  The shorter the better.
  54. ┌─┬─┬─┬─┬─┬─┬─┬─┬─┬─┐
  55. │ │ │ │ │ │ │ │ │ │ │
  56. └─┴─┴─┴─┴─┴─┴─┴─┴─┴─┘
  57. --------------------------- FOR OFFICE USE ONLY ------------------------------
  58.           ┌─┬─┬─┬─┬─┬─┐           ┌─┬─┬─┬─┬─┬─┬─┬─┐          ┌─┬─┬─┬─┬─┬─┬─┬─┐
  59.    T Code:│ │ │ │ │ │ │    T Date:│ │ │/│ │ │/│ │ │ Serial #:│ │ │ │ │ │ │ │ │
  60.           └─┴─┴─┴─┴─┴─┘           └─┴─┴─┴─┴─┴─┴─┴─┘          └─┴─┴─┴─┴─┴─┴─┴─┘
  61.                      TOLL FREE ORDER LINE: 1-800-525-3475
  62.               This copy of Client Keeper Plus was distributed
  63.                       by the Fosterburg BBS 618-432-7703.
  64.