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Text File  |  2000-03-31  |  1KB  |  51 lines
  1. FAX Registration Form
  2. ---------------------
  3.  
  4. From
  5.     Name:  _____________________________
  6.  
  7.     Phone: _________________________
  8.  
  9.     FAX:   _________________________
  10.  
  11. To
  12.     Name:  PalmGear H.Q.
  13.  
  14.     Phone: (800)741-9070
  15.  
  16.     FAX:   (817)640-6614
  17.  
  18.  
  19. RE: Flytrap registration
  20.  
  21.  
  22. Please register me for Flytrap as follows:
  23.  
  24.     HotSync username: _____________________________
  25.  
  26.     Email address:    ______________________________________
  27.  
  28. Please bill $10 to my credit card as follows:
  29.  
  30.     Credit card:  [ ] VISA   [ ] MasterCard   [ ] American Express
  31.  
  32.     Credit card number:  _____________________________
  33.  
  34.     Expiration date:     ____________
  35.  
  36.     Name on credit card: _____________________________
  37.  
  38.     Billing address:     _________________________________________
  39.  
  40.                          _________________________________________
  41.  
  42.     City:                _____________________________
  43.  
  44.     State:               ___________________
  45.  
  46.     ZIP:                 ___________________
  47.  
  48.     Country:             ___________________
  49.  
  50. ----End of Form----
  51.