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Text File  |  1997-05-07  |  3KB  |  61 lines
  1.                      The Streets Door Registration Form
  2.  
  3. Name _________________________________________________________________________
  4.  
  5. Address ______________________________________________________________________
  6.  
  7. City ________________   Province/State ___________   Postal/Zip Code _________
  8.  
  9. Country _________   Phone # - Voice ___________________ Data _________________
  10.                                                    
  11. BBS Name & Phone Number(s) (As will be in Registration Key):
  12.  
  13. ______________________________________________________________________________
  14. How would you like your key sent?  (As soon as Cheque clears... 8) )
  15.         
  16.         (  )  Postal Mail    -    (  ) 3-1/2 inch     (  ) 5-1/4 inch Diskette
  17.                              (* Please add $5 P&H *)
  18.         (  )  Fido Crash/Netmail  - Address:
  19.         (  )  Internet UUEncoded  - Address:
  20.         (  )  Download from my BBS  (Will be available under your FULL NAME)
  21.                   Password for your account:_________________
  22.  
  23. Is this your BBS or are you "Adopting" this BBS (Circle one)?   Sysop   Adopt
  24.  
  25. If adopting, what name would you like to have shown (leave blank for real name)
  26.  
  27. ______________________________________________________________________________
  28.  
  29. NOTE:  Please be sure to make out Cheque or M.O. (preferably), for $1O, to:
  30.  
  31.        ALLEN WALKER, P.O. Box 5874,  Victoria, B.C, Canada,  V8R 6S8
  32.  
  33. ┌─────────────────────────────────────────────────────────────────────────────┐
  34. │   If you want to pay for the door by VISA, I will need the following info:  │
  35. │                                                                             │
  36. │ Name (exactly as on Card): ________________________________________________ │
  37. │                                                                             │
  38. │ Visa Number: __________________________________    Expiry date: ___________ │
  39. │                                                                             │
  40. │   Since the VISA is charged in Canadian Funds, the following amounts apply: │
  41. │                                                                             │
  42. │                          Canadian Orders:  $1O.OO                           │
  43. │                          U.S.     Orders:  $13.OO                           │
  44. │                                                                             │
  45. │                         Postage & Handling:  $5.OO                          │
  46. │         (P&H only applies to me mailing you your Registration & Disk)       │
  47. │                                                                             │
  48. │                         Total Charge: $___________                          │
  49. │                                                                             │
  50. └─────────────────────────────────────────────────────────────────────────────┘
  51. What would you like to see in future doors:
  52.  
  53. (  ) Rip Graphics      (  ) Simple, Addictive Games   (  ) Puzzle/Mind Games
  54. (  ) More Ansii        (  ) Complex Strategy Games    (  ) Kids Games
  55. (  ) Utility Doors     (  ) Adult/R-Rated Games       (  ) Action Games
  56.  
  57. Comments/Suggestions:
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  61.