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Text File  |  1993-08-31  |  5KB  |  65 lines
  1. ┌─────────────────────────────────────────────────────────────────────────────┐
  2. │*Please PRINT Clearly!* REGISTRATION FORM FOR EZBREW *Please PRINT Clearly!* │
  3. ├──────────────────────────┬──────────────────────────────────────────────────┤
  4. │ Complete and return to:  │  Please provide your complete mailing address:   │
  5. │                          │                                                  │
  6. │     Jim Anderson         │  ______________________________________________  │
  7. │    217 Rooks Drive       │                                                  │
  8. │ Slidell, LA 70458 USA    │  ______________________________________________  │
  9. ├──────────────────────────┤                                                  │ 
  10. │                          │  ______________________________________________  │
  11. │ Jim's use only, please!  │                                                  │
  12. │                          │  ______________________________________________  │
  13. │ Recd:                    │                                                  │
  14. │                          │  State: ______ ZIP: _________ Country: ________  │
  15. │ Auth:                    │                                                  │
  16. │                          │  Phone (optional):                               │
  17. │ Sent:                    │                                                  │
  18. │                          │    Day: (_____) _____ - __________  ext _______  │
  19. │  PCC:                    │                                                  │
  20. │                          │  Night: (_____) _____ - __________  ext _______  │
  21. │                          │                                                  │
  22. ├──────────────────────────┴──────────────────────────────────────────────────┤
  23. │                                                                             │
  24. │  Qty  Product  (please specify disk size below)        Price       Total    │
  25. │                                                                             │
  26. │  ___  EZBREW Home Brewing System.                     $30.00     $________  │
  27. │                                                                             │
  28. │ ┌─┐             ┌─┐                                                         │
  29. │ │ │ 5.25" disk  │ │ 3.5" disk    (Add $1.00 for a 3.5" disk)     $________  │
  30. │ └─┘             └─┘                                                         │
  31. │                                                                             │
  32. │                     Total enclosed (U.S. funds only please!)     $________  │
  33. │                             (Make payable to "Jim Anderson")                │
  34. ├─────────────────────────────────────────────────────────────────────────────┤
  35. │ Please include a money order for the correct amount with your completed     │
  36. │ registration.  When I receive it, I'll send you the latest release of the   │
  37. │ program.  Thanks for your interest in and support of the EZBREW system.     │
  38. ├─────────────────────────────────────────────────────────────────────────────┤
  39. │                                - OPTIONAL -                                 │
  40. │                                                                             │
  41. │ Which evaluation release of EZBREW did you use? 1._____                     │
  42. │                                                                             │
  43. │ Where did you get your copy from?  __ Friend  __ Bulletin Board  __ Other   │
  44. │                                                                             │
  45. │ If you indicated "Bulletin Board" or "Other", please give some details:     │
  46. │                                                                             │
  47. │ __________________________________________________________________________  │
  48. │                                                                             │
  49. │ Are you an experienced home brewer or new to the hobby? __________________  │
  50. │                                                                             │
  51. │ Comments about EZBREW? ___________________________________________________  │
  52. │                                                                             │
  53. │ __________________________________________________________________________  │
  54. │                                                                             │
  55. │ __________________________________________________________________________  │
  56. │                                                                             │
  57. │ __________________________________________________________________________  │
  58. │                                                                             │
  59. │ __________________________________________________________________________  │
  60. │                                                                             │
  61. │ __________________________________________________________________________  │
  62. │                                                                             │
  63. │ __________________________________________________________________________  │
  64. └─────────────────────────────────────────────────────────────────────────────┘
  65.