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File List  |  1987-04-13  |  547b  |  27 lines
  1.  
  2.  
  3. Hello,
  4.  
  5. This is a sample questionaire, please enter the required information.
  6. Thanks.
  7.  
  8.                     [-----------------------]
  9. What is your name:
  10.  
  11.                     [--]
  12.   How old are you:
  13.  
  14.  
  15. TWO LINES WILL BE PROVIDED FOR ADDRESS:
  16.  
  17.                    [------------------------------------]
  18.    Street Address:
  19.                    [------------------------------------]
  20. City, State & Zip:
  21.  
  22.                                        [###-###-####]
  23. Telephone number (include Area Code):
  24.  
  25. THANKS FOR GIVING US A HAND!
  26.  
  27.