home *** CD-ROM | disk | FTP | other *** search
/ Power-Programmierung / CD1.mdf / pascal / library / dos / dossys / pwfossil / register.frm < prev   
Encoding:
Text File  |  1992-04-01  |  1.3 KB  |  46 lines
  1.                        ------------------------------
  2.                        Patchwork Software Development
  3.                          Product Registration Form
  4.                        ------------------------------
  5.  
  6.     Name ____________________________________________________
  7.  
  8.         Address _________________________________________________
  9.  
  10.         City ____________________________ State______ Zip _______
  11.  
  12.         Phone (____)______-________ Date Mailed _____/_____/_____
  13.  
  14.  
  15.                              ---------------
  16.                              Product Ordered
  17.                              ---------------
  18.  
  19.      [  ]  5 1/4" Version of PWFOSSIL 1.01 with          $7.50
  20.               source code and registered version
  21.  
  22.     [  ]  3 1/2" Version of PWFOSSIL 1.01 with         $10.00
  23.               source code and registered version
  24.  
  25.  
  26.                                                 TOTAL   $____.___
  27.  
  28.     Mail to:
  29.  
  30.     Jody Burrow
  31.     Patchwork Software Development
  32.      1611 E. Lark
  33.     Springfield, MO
  34.     65804-4351
  35.  
  36.     Make checks payable to Jody Burrow.
  37.     
  38.         
  39.                                   --------
  40.                                   Comments
  41.                                   --------
  42.  
  43.     Make all coments about this product and/or other products
  44.         you would like to see starting here and continue on the back 
  45.      if you need to.
  46.