home *** CD-ROM | disk | FTP | other *** search
-
- REAL VIDEO POKER for Windows 95 REGISTRATION
-
- Name ____________________________________________
-
- Company ____________________________________________
-
- Address ____________________________________________
-
- City/State ____________________________________________
-
- Zip Code _________ Country _________________________
-
- Phone ( ) ____-______ EMail ___________________
-
-
- DISK SIZE: ( ) 3-1/2" Diskette ( ) CD-ROM Disc
-
- I AM ORDERING:
- ( ) REAL Video Poker ($20)
- ( ) REAL Video Poker and REAL Video Blackjack ($25)
- ( ) REAL Video Poker & BJ and Noisy Video Poker & BJ ($30)
-
- ( ) Other ___________________________________________
- (Other Ultimate products--see catalog)
-
- INTERNATIONAL ORDERS
- --------------------
- Please add $4.00 for shipping if you live outside North America. For
- shipping to Canada or mexico add $2.00. Payment must be in U.S. funds
- drawn on a U.S. or Canadian bank. (no charge for shipping within the U.S.)
-
- Amount Enclosed: $_________
-
-
- Make your check or money order payable to ULTISOFT, Inc.
-
- Mail payment and registration form to ULTISOFT
- PO Box 5015
- Central Point, OR 97502
- USA
-
- Payment Method:
- ___ Check ___ Money Order ___ VISA ___ MasterCard
-
- Credit Card Number #_____ - _____ - _____ - _____ expires ____/____
-
-
- For credit card orders: Call 1-800-925-3147 (U.S. and Canada)
- 1-541-857-9229 (International)
- 1-541-734-3267 (FAX)
-
- ----------------------------------------------------------------------------
- SURVEY
-
- Do you have a CD-ROM drive? ( ) Yes ( ) No
-
-