home *** CD-ROM | disk | FTP | other *** search
/ Beijing Paradise BBS Backup / PARADISE.ISO / software / BBSDOORW / PSAL10.ZIP / REGISTER.FRM < prev    next >
Encoding:
Text File  |  1992-06-27  |  1.5 KB  |  59 lines
  1.  
  2.  
  3.  
  4.  
  5.                           Registration
  6. _________________________________________________________________
  7.  
  8.      Qty    Item                                    US  Price
  9.  
  10.      ___  Registration only ........................ @  $5 ea
  11. $________
  12.           (includes user name on ProScribe screen)
  13.  
  14.      ___  Registration & Future Upgrades ........... @ $15 ea
  15. $________
  16.           (includes user name on ProScribe screen &
  17.            next 3 updates sent through mail)
  18.           Please Specify:     _____ 5¼" disk OR
  19.                               _____ 3½" disk
  20.  
  21.                                                         TOTAL
  22. $________
  23.  
  24.      Remit To:           Brett Nyborg
  25.                          9238 S. Heather Dr.
  26.                          Tempe, AZ 85284
  27.  
  28.      Name 
  29. _____________________________________________________________
  30.  
  31.      Name to be displayed as registered to (Max 58 characters):
  32.  
  33.      
  34. _________________________________________________________________
  35. _
  36.  
  37.      Company 
  38. _________________________________________________________
  39.      or BBS
  40.  
  41.      Address 
  42. _________________________________________________________
  43.  
  44.              
  45. _________________________________________________________
  46.  
  47.              
  48. _________________________________________________________
  49.  
  50.  
  51.      Payment by:  ___ Check (U.S. bank or branch) ___ Money Order
  52.  
  53.      Work Phone (____) _____________  Home Phone (____) 
  54. ______________
  55.  
  56.      Signature
  57. ________________________________________________________
  58.  
  59.