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Text File  |  1994-12-27  |  3.5 KB  |  64 lines
  1.                            - Registration Form -
  2.                                - RASIS 2.01 -
  3.  
  4. Name:   ______________________________________ Phone: _____________________
  5.                                                 +-----------------------------+
  6. Address:______________________________________  |   *** Office Use Only ***   |
  7.                                                 | RD:  ___________            |
  8.         ______________________________________  | P#:  __________________     |
  9.                                                 | Code:______________________ |
  10.         ______________________________________  | ( )PHN  ( )M  ( )EM         |
  11.                                                 +-----------------------------+
  12. Node Address (if applicable): _________________ (FidoNet Only)
  13. ****************************************************************************
  14. This information is for your Registration Code, enter "exactly" as you
  15. wish it displayed, please type or print. Must be same as in RASIS.CFG
  16.  
  17. Sysop Name: _______________________________________________________
  18. *****************************************************************************
  19.   Shipping Method:
  20.  
  21.       [ ] On Disk    ( )5.25 1.2  ( ) 3.5 1.44k  ( )3.5 720k
  22.       [ ] File Attach: Valid address must be given above.
  23.       [ ] Send Registration Code via regular mail.
  24.       [ ] Will file request. (You will be notified when ready.)
  25.       [ ] Will download from BBS. (Must send completed PREBBS.FRM)
  26.  
  27.   Order Information:
  28.  
  29.   _______ Copy(s) of RASIS @  $20.00                   _____________
  30.  
  31.           On Disk: Add $2.00                           _____________
  32.  
  33.           Euro Check - Add $5.00                       _____________
  34.  
  35.           Sub Total:                                   _____________
  36.  
  37.   *** Outside U.S. and Canada, Add $5.00 (DISK)        _____________
  38.  
  39.                      Order Total:                      _____________
  40.   << Payment Amounts must be in U.S. Dollars. >>
  41.  
  42.  *************************CREDIT CARD ORDERS ONLY***************************
  43.  *                                                                         *
  44.  *   Name on Card: ________________________________________                *
  45.  *                                                                         *
  46.  *     Circle One:   VISA   MASTERCARD                                     *
  47.  *                                                                         *
  48.  * Card Number: _______________________________________________            *
  49.  *                                                                         *
  50.  * Expiration Date: ___________________                                    *
  51.  *                                                                         *
  52.  * Phone Number to reach you at: _____________________________             *
  53.  * Required                                                                *
  54.  * Signature: __________________________________________________           *
  55.  * [   ] I understand that Damar Enterprises will show on my statement     *
  56.  *       for this charge.  MUST BE INITIALED!                              *
  57.  * Do you need a receipt mailed to you?  ( )YES   ( )NO                    *
  58.  ***********************ALL INFORMATION IS REQUIRED*************************
  59.  
  60.    Mail form/payment,"payable" to:       RaLin Enterprises
  61.    Credit Card Orders may                4641 Wheeler Dr.=OR=
  62.    Send form via Netmail.                40728 Sundale Dr.
  63.                                          Fremont, Ca. 94538-3341
  64.