home *** CD-ROM | disk | FTP | other *** search
/ Programmer 7500 / MAX_PROGRAMMERS.iso / PASCAL / TESS_PD.ZIP / ORDER.FRM next >
Encoding:
Text File  |  1988-07-03  |  1.6 KB  |  50 lines
  1.  
  2.                                 Order Form
  3.  
  4.                TesSeRact(TM) Products And Registration Form
  5.  
  6.  
  7.      Name:          ______________________________________
  8.      
  9.      Address:       ______________________________________
  10.      
  11.                     ______________________________________
  12.      
  13.      City:          ______________________________________
  14.      
  15.      State:         __________________________ Zip: ______
  16.      
  17.      Telephone:     ______________________________________
  18.      
  19.      Primary Language:   _________________________________
  20.      
  21.      Item                                      Quantity      Total
  22.      --------------------------------------------------------------
  23.      TesSeRact Registration ($25 each)___________________|_________
  24.      
  25.      TesSeRact Source Code License ($25 each)____________|_________
  26.      
  27.      TesSeRact Trial Disk ($10)__________________________|_________
  28.      
  29.      Monthly Information NewsLetter______________________|_________
  30.         ($10 per year)
  31.      
  32.      Product Identification String (Free!!)______________|_________
  33.         Your ID String: _____________________
  34.         Product Name:   _____________________
  35.      
  36.      --------------------------------------------------------------
  37.      Total Due:                                          |_________
  38.      
  39.      
  40.      Preferred Disk Size:  3.5" ____  5.25" ____
  41.      
  42.      
  43.      Mail Completed Form to:
  44.      
  45.                     TesSeRact Development Team
  46.                     2084 Woodlawn Avenue
  47.                     Glenside, PA 19038
  48.  
  49.  
  50.