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  1. To register any BCI Associates product, send payment according to the
  2. schedule shown below. Print this out and fill it in, or edit this form
  3. and then print that out.
  4.  
  5. We accept international money orders drawn on US funds, and US Postal
  6. Money Orders as well. Make checks and money orders (drawn on a US bank)
  7. payable to:
  8.  
  9. Jeff Bankston
  10. 3401 Eland Downe RT113
  11. Phoenixville, Pa 19460
  12. USA
  13.  
  14. Date: ___________  Diskette size: 5 1/4 ____  3 1/2 ____  HD ____
  15.  
  16. Name ________________________________________________________________
  17.  
  18. Address _____________________________________________________________
  19.  
  20. City ________________________________________________________________
  21.  
  22. State _____________ ZipCode _____________________ Country ___________
  23.  
  24. Phone number __________________________ CompuServe __________________
  25.  
  26.  
  27. Product             Quantity            Price           Amount
  28. SPTEST              ________     X      $20.00    =     ________
  29. LPTRST              ________     X      $15.00    =     ________
  30. LETTER              ________     X      $10.00    =     ________
  31. CATDOS              ________     X      $25.00    =     ________
  32. CATWIN              ________     X      $25.00    =     ________
  33.  
  34.                                         Subtotal        ________
  35.                                         
  36.                                         PA tax (6%) +   ________
  37.                                         
  38.                             (if required)   S&H     +   ________
  39.                                         ($5 per pkg)
  40.                                         
  41.                                         Order total     ________
  42.  
  43.  
  44. Comments ____________________________________________________________
  45.  
  46. _____________________________________________________________________
  47.  
  48. _____________________________________________________________________
  49.  
  50. _____________________________________________________________________
  51.  
  52.