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Text File  |  1998-11-12  |  2KB  |  53 lines
  1.  
  2.                     NOISY VIDEO POKER & BLACKJACK REGISTRATION
  3.  
  4.           Name             ________________________________________
  5.  
  6.           Company          ________________________________________
  7.  
  8.           Address          ________________________________________
  9.  
  10.           City/State       ________________________________________
  11.  
  12.           Zip/Postal Code  ________________________________________
  13.  
  14.           Country          ________________________________________
  15.  
  16.           Phone            ________________________________________
  17.  
  18.           EMAIL ADDRESS    ________________________________________
  19.                            If you include your eMail address, we can
  20.                            send you the registration code immediately.
  21.  
  22.      DISK SIZE:  (  ) 3-1/2"   (  ) CD-ROM
  23.  
  24.      I AM ORDERING:   (  ) Only Noisy Video Poker ($20)
  25.                       (  ) Only Noisy Video BlackJack ($20)
  26.                       (  ) BOTH Noisy Video Poker and BlackJack ($25)
  27.                       (  ) Noisy Video Poker/BJ and REAL Video Poker/BJ ($30)
  28.  
  29.      SHIPPING CHARGES
  30.      --------------------
  31.      Please add $2.00 for shipping if you live in the United States.
  32.      For shipping to all other countries, please add $4.00 per order.
  33.  
  34.      Amount Enclosed: $_________
  35.  
  36.      Make your check or money order payable to ULTISOFT.
  37.  
  38.      Mail payment and registration form to:    ULTISOFT
  39.                                                PO Box 5015
  40.                                                Central Point, OR 97502
  41.                                                USA
  42.      Payment Method:
  43.                      ___ Check   ___ Money Order   ___ VISA   ___ MasterCard
  44.  
  45.      Credit Card Number #_____ - _____ - _____ - _____   expires ____/____
  46.  
  47.      For credit card orders:  Call 1-800-925-3147 (U.S. and Canada)
  48.                                    1-541-664-1885 (International)
  49.                                    1-541-664-3403 (FAX)
  50.  
  51.      Order Online at:         http://www.ultisoft.com
  52.  
  53.