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  1. Dialog View Registration Form
  2.  
  3. Name:        ________________________________
  4.  
  5. Company:   ________________________________
  6.  
  7. Address:    ________________________________
  8.  
  9.                   ________________________________
  10.  
  11.                   ________________________________
  12.  
  13. E-mail:       ________________________________
  14.  
  15.  
  16. Item                                                  Quantity       Unit Price      Total
  17.  
  18. Dialog View 2.0                                 ______         $10                 ____
  19.  
  20. Shipping (purchase orders only)                              $5                  ____
  21.  
  22. Total                                                                                             ____
  23.  
  24.  
  25. Payment method:    cash ___    check ___    money order ___    purchase order ___
  26.  
  27.  
  28. Mail to:
  29.                     James W. Walker
  30.                     3200 Heyward Street
  31.                     Columbia, SC  29205
  32.  
  33.  
  34.