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Text File  |  1997-02-27  |  2KB  |  53 lines
  1. Complete the form below to register your Infoflex software programs.
  2.  
  3. FLEXED REGISTRATION FORM 
  4. ========================
  5. PROGRAM:                                # COPIES         AMOUNT
  6.  
  7.  
  8. GPOKER 95 (US $20.00)                       ______      $________
  9.  
  10. Add $10.00 Postage & Handling if Required   ______      $________
  11.            
  12. TOTAL         . . . . . . . . . . . . . . . . . . . . . $________
  13.  
  14. PAYMENT INFORMATION:
  15. ====================
  16.  
  17. MasterCard ___   Visa ___   Bankcard ___   Cheque/Money Order ___
  18.  
  19. Card Number      :__________|___________|____________|___________
  20.  
  21. Expiry Date      :____/____
  22.  
  23. Card Issued To   :_______________________________________________
  24.  
  25. Signature        :_______________________________________________
  26.                                                                       
  27. MAILING ADDRESS:
  28. ================
  29.  
  30. Name             :_______________________________________________
  31.  
  32. Address          :_______________________________________________
  33.  
  34. City/State       :_______________________________________________
  35.  
  36. Country/PostCode :_______________________________________________
  37.  
  38. Voice/FAX/Modem  :_______________________________________________
  39.  
  40. Email Address    :_______________________________________________
  41. _________________________________________________________________
  42. FAX  :      Registration Forms to +61 2 9894-2067 (Australia)
  43. PHONE:                            +61 2 9894-1313 (Australia)
  44. MAIL :      Infoflex Pty Ltd 
  45.             Unit 27, 15 Terminus Street
  46.             Castle Hill, 2154 NSW
  47.             AUSTRALIA
  48. _________________________________________________________________
  49.  Internet Email: sales@infoflex.com.au  
  50.    Internet FTP: ftp.infoflex.com.au
  51.             WWW: http://www.infoflex.com.au
  52. _________________________________________________________________
  53.