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  1. Registration form for 15-Pack
  2. -----------------------------
  3.  
  4. Program No.: 106546
  5.  
  6. Registration fee: $12
  7.  
  8. Last name: _______________________________________________
  9.  
  10. First name: ______________________________________________
  11.  
  12. Company: _________________________________________________
  13.  
  14. Street and #: ____________________________________________
  15.  
  16. City, State, postal code: ________________________________
  17.  
  18. Country: _________________________________________________
  19.  
  20. Phone: ___________________________________________________
  21.  
  22. Fax: _____________________________________________________
  23.  
  24. E-Mail: __________________________________________________
  25.  
  26. *** Please do not forget to include your e-mail address. ***
  27. *** We will use e-mail to communicate with you. ***
  28.  
  29.  
  30. How would like to receive the registration key/full version?
  31.  
  32.  __ e-mail   __ fax   __ postal mail
  33.  
  34.  
  35. How would you like to pay the registration fee:
  36.  
  37.  __ credit card   __ wire transfer   __ EuroCheque   __ cash
  38.  
  39.  
  40. Credit card information (if applicable)
  41.  
  42. Credit card:  __ Visa   __ Eurocard/Mastercard
  43.           __ American Express   __ Diners Club
  44.  
  45. Card holder: ________________________________
  46.  
  47. Card No.: ___________________________________ Expiration Date: ________
  48.  
  49.  
  50.  
  51. Date / Signature: ___________________________
  52.