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Text File  |  1993-06-18  |  2.5 KB  |  32 lines
  1. +-----------------------------------------------------------------------------+
  2. |                        List Maker Registration Form                         |
  3. |                                                                             |
  4. |                                                                             |
  5. | Name_________________________________                                       |
  6. | Company______________________________                                       |
  7. | Address______________________________                                       |
  8. | City__________State_____Zip__________                                       |
  9. | Phone (____) ____ - ____                                                    |
  10. |                                                                             |
  11. |                                                                             |
  12. | Send check to:               Check One:                                     |
  13. | ELDON MARTIN                __ Registration for List Maker.......... $10.00 |
  14. | HCR 75  BOX 99              __ Registration and Source Code in              |
  15. | MCCONELLSBURG, PA  17233                             QuickBasic..... $35.00 |
  16. |                                PA Residents Add 6% Sales Tax........ $__.__ |
  17. | Disk Size: __3 1/2   __5 1/4                                                |
  18. |                                                 Total Money Enclosed $__.__ |
  19. |                                                                             |
  20. |                     ------------------------------                          |
  21. |                                                                             |
  22. |  What type of computer do you have?            What type of graphics card?  |
  23. |  __ 286                                         __ CGA                      |
  24. |  __ 386                                         __ EGA                      |
  25. |  __ 486                                         __ VGA                      |
  26. |  __ Other                                       __ Super VGA                |
  27. |                                                                             |
  28. |  Where did you recieve this program? _____________________________________  |
  29. |                                                                             |
  30. |                                                                             |
  31. +-----------------------------------------------------------------------------+
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