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Text File  |  1994-09-01  |  2KB  |  45 lines
  1.     Please add me as a supporter of LIST, version 9.0h:
  2.  
  3.     Name    ______________________________________________________________
  4.  
  5.     Company ______________________________________________________________
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  7.     Address ______________________________________________________________
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  9.             ______________________________________________________________
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  11.     City    ________________________________State _______ Zip ____________
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  14.     Amount  $____________________Copies _________   Date   _______________
  15.  
  16.     (  )  Check or money order payable to Vernon D. Buerg in U.S. funds
  17.  
  18.     (  )  VISA    (  )  MasterCard        (  ) 5.25" disk   (  ) 3.5" disk
  19.  
  20.     Credit card number __________________________________ Exp date _______
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  23.                                     [tape]
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  25.                                                                  -------
  26.                                                                 | place |
  27.                                                                 | stamp |
  28.                                                                 | here  |
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  36.                  Vernon D. Buerg
  37.                  139 White Oak Circle
  38.                  Petaluma, CA
  39.                                  94952
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