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Text File  |  1995-09-08  |  2KB  |  51 lines
  1.                    REGISTRATION/ORDER FORM               IW20
  2.  
  3. To: ARK ANGLES        Phone: (047)588100 or Intl+61-47-588100
  4.     P O Box 190       Fax:   (047)588638 or Intl+61-47-588638
  5.     Hazelbrook 2779   Internet:     100237.141@compuserve.com
  6.     AUSTRALIA         CompuServe:                  100237,141
  7.  
  8. Name    _____________________________________________________
  9.  
  10. Company _____________________________________________________
  11.  
  12. Address _____________________________________________________
  13.  
  14. Town    ________________________  State _______  Code _______
  15.  
  16. Country _____________________________________________________
  17.  
  18. Phone   ___________________________  Fax ____________________
  19.  
  20. E-mail  _____________________________________________________
  21.  
  22. Where software seen or obtained _____________________________
  23. Computer:  [ ] XT   [ ] AT/286   [ ] 386   [ ] 486   [ ] >486
  24. Memory Size: ____________    Hard Disk Size: __________
  25. Drives: [ ] 5.25 360K [ ] 3.5 720K [ ] 5.25 1.2M [ ] 3.5 1.4M
  26. Screen: [ ] Mono/Herc  [ ] CGA   [ ] EGA   [ ] VGA   [ ] >VGA
  27. Dos Ver# ________   Windows Ver# ________   OS/2 Ver# _______
  28.  _______________________________________ _______ ___________
  29. | P R O D U C T  /  L I C E N S E       | Q T Y | P R I C E |
  30. |_______________________________________|_______|___________|
  31. |                                       |       |           |
  32. |_______________________________________|_______|___________|
  33. |                                       |       |           |
  34. |_______________________________________|_______|___________|
  35. |                                       |       |           |
  36. |_______________________________________|_______|___________|
  37. |                                       |       |           |
  38. |_______________________________________|_______|___________|
  39. | T O T A L                                     |           |
  40. |_______________________________________________|___________|
  41.  
  42. [ ] Bankcard  [ ] Mastercard  [ ] Visa  [ ] Cash/Cheque/Draft
  43.  
  44. Credit Card No  _____ _____ _____ _____   Expiry Date ___/___
  45.  
  46. Cardholder Name _____________________________________________
  47.  
  48. Signature       ___________________________   Date __________
  49.  
  50. Comments:
  51.