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Text File  |  1997-08-15  |  2KB  |  51 lines
  1.                    REGISTRATION/ORDER FORM
  2.  
  3. To: ENSIGN SYSTEMS, 21 TREDOWN ROAD, SYDENHAM, LONDON SE26 5QQ
  4.  
  5. TELEPHONE 0181-778-2871         FAX 0181-776-8477
  6. EMAIL: EnsignPub@aol.com        Web site: http://www.ensignpub.com
  7.  
  8.  
  9. Name    _____________________________________________________
  10.  
  11. Company _____________________________________________________
  12.  
  13. Address _____________________________________________________
  14.  
  15. Town    ________________________ PostCode _______
  16.  
  17. Country _____________________________________________________
  18.  
  19. Phone   __________________________  Fax _____________________
  20.  
  21. E-mail  _____________________________________________________
  22.  
  23. Where software seen or obtained _____________________________
  24.  
  25. Disk: 3.5" High Density
  26.  
  27. Windows 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. [ ]Mastercard  [ ]Visa   [ ]Cash/Cheque
  43.  
  44. Credit Card No  _____ _____ _____ _____   Expiry Date ___/___
  45.  
  46. Cardholder Name _____________________________________________
  47.  
  48. Signature       ___________________________   Date __________
  49.  
  50. Comments:
  51.