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TEXT_-4064.txt
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1997-06-17
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GoMac 1.2 Registration Form
Send this form with payment to: Proteron
Attn: GoMac Sales
9600 East 150 Highway
Kansas City, MO 64149
Internet registration at http://www.proteron.com/gomac
====================== Registration Information ======================
<LastName>, <FirstName> <MI>
<Company>
<Address1>
<Address2>
<City>, <State> <Zip>
<Country>
*EMail: <EMail>
------------------------ Purchase Information ------------------------
Purchase Quantity: <Copies> copies
<Copies1995> at $19.95
<Copies0500> at $5.00
Bulk Purchase Price:
<Copies1495> at $14.95
Total cost: <Total>
------------------------ Payment Information -------------------------
**Payment Method: <Pmt>
Credit Card Information
Name on Card: <CCName>
Card Number: <CC#> Exp. Date: <ExpDate>
First Virtual Information
FV Account: <FV#>
----------------------------------------------------------------------
*If you include an email address, you will receive your serial number
via email within 48 hours after we receive this form.
**REMEMBER: If paying by Check/Money Order, be sure to include payment.