home *** CD-ROM | disk | FTP | other *** search
/ Graphics Plus / Graphics Plus.iso / msdos / plotting / splt251 / order.frm < prev    next >
Encoding:
Text File  |  1993-08-01  |  2.5 KB  |  67 lines
  1.       Order Form for SPLOT - The Pen Plotter Simulator (MS-DOS version)
  2.               To mail this form, please use a registered mail.
  3.  
  4.  Your Name: _____________________________________________________________
  5.  
  6.  Company: _______________________________________________________________
  7.  
  8.  Address: _______________________________________________________________
  9.  
  10.     City: _____________________________ Prov/State: _____________________
  11.  
  12.  Country: _____________________________ ZIP/Postal: _____________________
  13.  
  14.  If you are registered user already, your serial number: ________________
  15.  
  16.   Licence:     [ ]  single user         [ ]  multisystem site
  17.  
  18.   Disk:        [ ]  5 1/4 inch          [ ]  3 1/2 inch
  19.  
  20.   Payment:     [ ]  Cash (money enclosed)
  21.                [ ]  Credit card (fill out credit card information below)
  22.                [ ]  Bank or travelers cheque (payable in US funds)
  23.  
  24.   I'd like to order the SPLOT program for the following plotter type(s):
  25.  
  26.   [ ] HP 7470A ............................................ ___________ USD
  27.  
  28.   [ ] HP 7475A ........................................... ____________ USD
  29.  
  30.   [ ] HP 7440A ColorPro .................................. ____________ USD
  31.  
  32.   [ ] HP 7550A ........................................... ____________ USD
  33.  
  34.   [ ] HP DraftPro ........................................ ____________ USD
  35.  
  36.   [ ] HP DraftMaster ..................................... ____________ USD
  37.  
  38.   [ ] Roland DXY ......................................... ____________ USD
  39.  
  40.   Shipping (Outside Europe) .............................. ____________ USD
  41.  
  42.   TOTAL AMOUNT ( US dollars ) ............................ ____________ USD 
  43.  
  44.  
  45.   I hereby authorize the above amount to be charged to my
  46.  
  47.      [ ] MasterCard          [ ] VISA          [ ] American Express
  48.  
  49.   Name as it appears on card:__________________________________________
  50.  
  51.   Credit card number:_______________________ Expiration date:__________
  52.  
  53.   Signature:_________________________________
  54.  
  55.  
  56.   Your comments: ________________________________________________________
  57.  
  58.   _______________________________________________________________________
  59.  
  60.   _______________________________________________________________________
  61.             (add any additional comments you wish separately)
  62.  
  63.         Mail this form to:      Alexandr Novy
  64.                                 Havlickova 2209
  65.                                 390 01 TABOR
  66.                                 Czech Republic
  67.