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Text File  |  1997-09-02  |  3KB  |  46 lines
  1. Mapedit Registration Form
  2.  
  3. Please fill out this form, print it out, and mail or fax it to us WITH PAYMENT at the following address:
  4.  
  5. Boutell.Com, Inc.
  6. PO Box 20837
  7. Seattle, WA 98102
  8. +1 206 325 3009 
  9.  
  10. For ALL CUSTOMERS 
  11.  
  12. Your Name: ______________________                                                                                                                                                                          Address Line 1:    _____________________                                                                                                                                                   Address Line 2:  _____________________                                                                                                                                                 
  13. Address Line 3:  _____________________                                                                                                                                           Email Address: ___________________                                                                                                                                               
  14.  
  15. PRICING
  16.  
  17. Each copy costs $25 unless you qualify for free keys (see below). See our web site for volume discount information. 
  18.  
  19. Copies:  ____
  20. Total Price: US$ ________
  21.                                                                                               
  22. STATUS
  23.  
  24. Nonprofit organizations and primary schools, secondary schools, colleges and universities who provide PROOF OF THEIR STATUS such as letterhead can register Mapedit for free. We do not give free keys to governments, quasi-governmental organizations or corporate trainers. You must include an email address to get a free key. 
  25.  
  26. CHECK ONE: Nonprofit [ ]   Educational [ ]   OTHER [ ]
  27.  
  28. PAYMENT TYPE
  29.                                                                                                                             
  30. Organizations that qualify for free keys may select Waived. All other organizations must specify a form of payment and include payment or a purchase order form with their order. Checks must be in US funds drawn on a US bank. 
  31.  
  32. CHECK ONE: Check [ ]  Credit Card [ ]  Money Order [ ]  Purchase Order [ ]  Waived [ ] 
  33.  
  34. FOR THOSE ORDERING BY CREDIT CARD
  35.  
  36. Credit Card (WE DO NOT ACCEPT AMERICAN EXPRESS!)
  37.  
  38. CHECK ONE: Discover [ ]  Visa [ ]  Mastercard [ ]
  39.  
  40. Card Number: __________________________   Expiration Date: __/__
  41. Card Holder's Name: _________________________
  42.                                                                                                           
  43. For Those Ordering By Purchase Order (Note: You Must Include Your Purchase Order Form!)                    
  44.  
  45. PO Number: ____________________________
  46.