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Text File  |  1991-11-28  |  3KB  |  60 lines
  1.      ---------------------- REGISTER AND ORDER FORM ---------------------- 
  2.                                                                            
  3.                                                                            
  4.                                                                            
  5.                                                                            
  6.                                                                            
  7.                                                                            
  8.      TO ORDER AND REGISTER EASY WORD FOR CONTINUED USAGE, COMPLETE THE     
  9.      FORM BELOW AND ENCLOSE THE PROPER PAYMENT.                            
  10.                                                                            
  11.      NAME:_______________________________________________________________  
  12.                                                                            
  13.      STREET ADDRESS:_____________________________________________________  
  14.                                                                            
  15.      CITY:___________________________________________ST:_____ZIP:________  
  16.                                                                            
  17.      PHONE:_______________________ALTERNATE PHONE:_______________________  
  18.                                                                            
  19.      NAME TO APPEAR ON REGISTERED VERSION:_______________________________  
  20.                                                                            
  21.                                                                            
  22.      EASY WORD REGISTRATION          QTY:_____@ $19.00 EA.    $__________  
  23.                                                                            
  24.      UPDATED EASY WORD               QTY:_____@ $10.00 EA.    $__________  
  25.                                                                            
  26.           DISKETTE SIZE: [  ] 3.5"    [  ] 5.25"                           
  27.                                                                            
  28.           KENTUCKY RESIDENTS ADD 6% SALES TAX                 $__________  
  29.                                                                            
  30.                                                   TOTAL       $__________  
  31.                                                                            
  32.                                                                            
  33.                                                                            
  34.                                                                            
  35.                         REMIT TO:  HASLAM PROGRAMS                         
  36.                                    P.O. BOX 122                            
  37.                                    DIXON,KY 42409                          
  38.                                                                            
  39.      PHONE: 502/639-5787                                                   
  40.      _____________________________________________________________________ 
  41.      EASY WORD           VERSION 1.01                                      
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