home *** CD-ROM | disk | FTP | other *** search
- +---------------------------------------------------------+
- | To : Brad Vonarx |
- | P.O. Box 801 |
- | Croydon 3136 |
- | Victoria, AUSTRALIA |
- | __ |
- | |__| Please send me one Private Registration key |
- | for EzyEdit for $25 AUD |
- | OR |
- | __ |
- | |__| Please send me one Commercial Registration key |
- | for EzyEdit for $40 AUD |
- | |
- | Please charge the registration key to my credit card. |
- | __ __ __ |
- | Card Type : |__| MasterCard |__| Visa |__| Bankcard |
- | |
- | My Full Card Number is : |
- | |
- | |
- | └─┴─┴─┴─┘ └─┴─┴─┴─┘ └─┴─┴─┴─┘ └─┴─┴─┴─┘ |
- | |
- | Valid From ___/___/___ Until End ___/___/___ |
- | |
- | Name on Card : _______________________________________ |
- | |
- | Address : _______________________________________ |
- | |
- | ____________________ Post Code : ______ |
- | |
- | Signature of Cardholder : _____________________________ |
- | |
- +---------------------------------------------------------+
-