ORDER FORM FOR LUKE'S SCREEN SAVER I ------------------------------------ To order, print this out, fill it out neatly, include a cheque or money order and mail to: Luke Chao 30 Desjardins Crt. Hamilton, Ontario, Canada L8S 3R8 Please see the file LUKES_SS.HLP for more information. - Snip ------------------------- Cut here ------------------------- Snip - Registation for Luke's Screen Saver 1.02 ---------------------------------------- Date (MM/DD/YYYY): ________________ Your registration name or company (appears in About box): ___________________________________ Your real name: ___________________ Company/organization (if applicable): ___________________________________ Your postal address: ___________________________________ ___________________________________ ___________________________________ ___________________________________ ___________________________________ Home/Day Phone (including area code): ___________________________________ Work/Evening Phone (optional): ___________________________________ [ ]DON'T send me high density disks [ ]DON'T put me on your e-mail* mailing list [ ]I am NOT capable of unzipping ZIP files [ ]I have registered one of your programs before If you checked the above, what are your Customer and Invoice IDs from your previous order? (See the top of your invoice for these). ___________________________________ Quantity (registration): __________ X $10 Discount for multiple orders: -_______ Quantity (source code): __________ X $25 Discount for multiple orders: -_______ Upgrades: Postal mail (US/Canada): __________ X $5 Postal mail (Int'l): __________ X $10 E-mail*: __________ Subtotal: $_______ Shipping and handling (registration and source code only): ( )E-mail* ( )Postal (US/Canada): __________ X $5 ( )Postal (Int'l): __________ X $10 Total (pay this amount in US/CND dollars): $_______ Payment method: [ ]Cheque (made payable to "Luke Chao") [ ]Money order [ ]Cash (Please send by registered mail) * If you're using Internet e-mail, what is your e-mail address? ___________________________________ How do you want it to be sent to you (e-mail only)? ( )MIME Attachment ( )UUEncoded ---------------------------- | Questionaire (optional): | ---------------------------- Birthdate (MM/DD/YYYY): ___________ Fax number: _______________________ What languages do you speak? _________________________________________________________________________ What's your occupation? ________________________________________________ Your computer (RAM, processor, etc.): ___________________________________ Your operating system(s) (besides DOS): [ ]Win 3.1 [ ]Win 3.11 [ ]Win 95 [ ]Win NT [ ]OS/2 [ ]Other: ____________ What resolution are you using in Windows? [ ]640 x 480 [ ]800 x 600 [ ]1024 x 768 [ ]1280 x 1024 [ ]Other: ________ Where did you hear about this and/or where did you get it from? _________________________________________________________________________ What made you decide to register? _________________________________________________________________________ Your web page (on the Internet): http://__________________________________________________________________ Internet e-mail address(s), if different from above: _________________________________________________________________________ If you would rate this program on a scale of 1 to 10 (10 being the highest), what would you give it? (Circle one of the numbers): 1 2 3 4 5 6 7 8 9 10 Other: ______ What do you like the most/least about this program? _________________________________________________________________________ On a scale of one to ten, what would you rate your experience with computers? (One being beginner): 1 2 3 4 5 6 7 8 9 10 Other: ______ I'm using this program: [ ]At home [ ]At the office [ ]At school [ ]Other: ______________________ Comments/questions/suggestions, etc. (if you want the program shipped to a different address, please say so here): _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ _________________________________________________________________________ - Snip ------------------------- Cut here ------------------------- Snip - Thank you for supporting the Shareware concept. If you want any more information, you can contact me by Internet e-mail at: luke.chao@freenet.hamilton.on.ca or you can drop by my home page at: http://www.freenet.hamilton.on.ca/~ab470/