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Text File  |  1993-10-07  |  3KB  |  47 lines
  1.                                       ┌───────────────────────────────────────┐
  2.                                       │ Sébastien CHATARD                     │
  3.                                       │ 1, rue des Lacs                       │
  4.                                       │ 91350 GRIGNY                          │
  5.                                       └───────────────────────────────────────┘
  6.  
  7. Demande d'enregistrement à COPYVIT.
  8.  
  9. Nom         __________________________________________
  10.  
  11. Prénom      _____________________________
  12.  
  13. Adresse     __________________________________________
  14.  
  15.             __________________________________________
  16.  
  17. CP Ville    ______ ___________________________________
  18.  
  19. ┌────────────────────────────────────────────────┬──────┬──────────┬─────────┐
  20. │ Libellé                                        │  Nb  │Prix unit.│  Total  │
  21. ├────────────────────────────────────────────────┼──────┼──────────┼─────────┤
  22. │                                                │      │          │         │
  23. │ Programme COPYVIT                              │  __  │      100 │  ______ │
  24. │ Frais d'envoi                                  │      │       20 │         │
  25. ├────────────────────────────────────────────────┼──────┼──────────┼─────────┤
  26. │ Total                                          │  __  │          │ _______ │
  27. └────────────────────────────────────────────────┴──────┴──────────┴─────────┘
  28.  
  29. ┌────────────────────────────────────────────────────────────────────────────┐
  30. │                                                                            │
  31. │  Format disquette      3"1/2     ou     5"1/4                              │
  32. │                                                                            │
  33. │  Comment avez-vous connu COPYVIT ? ______________________________________  │
  34. │  ________________________________________________________________________  │
  35. │  ________________________________________________________________________  │
  36. │  ________________________________________________________________________  │
  37. │                                                                            │
  38. │  Avez-vous des suggestions à faire ? ____________________________________  │
  39. │  ________________________________________________________________________  │
  40. │  ________________________________________________________________________  │
  41. │  ________________________________________________________________________  │
  42. │  ________________________________________________________________________  │
  43. │                                                                            │
  44. └────────────────────────────────────────────────────────────────────────────┘
  45.  
  46. Règlements acceptés par chèque, mandat
  47.