home *** CD-ROM | disk | FTP | other *** search
/ In'side Shareware 1995 April / ish0495.iso / spiele / fuzzy / order.frm < prev    next >
Text File  |  1995-05-09  |  2KB  |  57 lines
  1.             Fuzzy's World Version 1.00s - Order Form
  2. ******************************************************************************
  3.  
  4. <<<Pixel Painters will keep your personal information strictly confidential>>>
  5.  
  6. General:
  7.  
  8.     First Name:       __________________________________________________
  9.  
  10.     Last Name:        __________________________________________________
  11.  
  12.     Address:          __________________________________________________
  13.  
  14.     City:             __________________________________________________
  15.  
  16.     State:            __________________________________________________
  17.  
  18.     Country:          __________________________________________________
  19.  
  20.     Zip/Postal Code:  __________________________________________________
  21.  
  22.     Phone #:          __________________________________________________
  23.  
  24.  - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
  25.  
  26.     Quantity:    ________ X $27.95 (US Orders Only)             ________
  27.  
  28.          ________ X US$35.00 (International Orders)     ________
  29.  
  30.     Sales Tax (Virgina residents only, please add 4.5%):        ________
  31.  
  32.     Shipping/Handling (Quantity X $3.00 for US Orders Only)     ________
  33.  
  34.     Total:                                                      ________
  35.  
  36.         ( Note: Please allow 1 to 2 weeks for delivery )
  37.  
  38.  - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - - -
  39.  
  40. Please tell us how you obtained this program. It will help us to bring you
  41. updates and future programs more quickly:
  42.  
  43.     ____ Software Creations BBS
  44.  
  45.     ____ CompuServe      ____ America On-Line   ____ Prodigy
  46.  
  47.     ____ ZiffNet         ____ Friend
  48.  
  49.     ____ Local BBS, please specify name & phone number:
  50.          ______________________________________________________________
  51.  
  52.     ____ Catalog/Shareware CD, please specify name:
  53.          ______________________________________________________________
  54.  
  55. *****************************************************************************
  56.   Pixel Painters Corporation * PO Box 2847 * Merrifield * Virginia * 22116
  57.