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Text File  |  1996-04-23  |  2KB  |  50 lines
  1.  
  2.                            WAVmaker Registration Form
  3.                            --------------------------
  4.  
  5.                                                           Date ______________
  6.  
  7.      Name ___________________________________________________________________
  8.  
  9.      [Company] ______________________________________________________________
  10.  
  11.      [Title] ________________________________________________________________
  12.  
  13.      Address ________________________________________________________________
  14.  
  15.      City __________________________  State/Country _________________________
  16.  
  17.      Zip ___________________________  [Phone] _______________________________
  18.  
  19.      [E-mail address] _______________________________________________________
  20.  
  21.      I got WAVmaker version ___ [from] ______________________________________
  22.  
  23.      [Comments/suggestions] _________________________________________________
  24.  
  25.      ________________________________________________________________________
  26.  
  27.      ________________________________________________________________________
  28.  
  29.  
  30.      One (1) Standard Registration at $40 US                           ______
  31.  
  32.      One (1) Advanced Registration at $60 US                           ______
  33.  
  34.      Shipping & Handling: if you are in the European Union, $5 US      ______
  35.  
  36.                           otherwise, $10 US                            ______
  37.  
  38.      TOTAL ORDER                                                       ______
  39.  
  40.      Payment method:  [ ]*MasterCard       [ ]*Visa
  41.                       [ ] Bank transfer    [ ] Postal giro
  42.                       [ ] Check            [ ] Cash
  43.                       [ ]*Money order      
  44.  
  45.      (*: Through NorthStar Solutions only)
  46.  
  47.  
  48.      Card #:________________ Exp:____/____ Signature:________________________
  49.  
  50.