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Text File  |  1998-06-11  |  2KB  |  55 lines
  1.  
  2.                            ANIMATED KENO REGISTRATION
  3.  
  4.           Name             ________________________________________
  5.  
  6.           Company          ________________________________________
  7.  
  8.           Address          ________________________________________
  9.  
  10.           City/State       ________________________________________
  11.  
  12.           Zip/Postal Code  ________________________________________
  13.  
  14.           Country          ________________________________________
  15.  
  16.           Phone            ________________________________________
  17.  
  18.           EMAIL ADDRESS    ________________________________________
  19.                            If you include your eMail address, we can
  20.                            send you the immediately.
  21.  
  22.      DISK SIZE:  (  ) 3-1/2"   (  ) CD-ROM
  23.  
  24.      I AM ORDERING:
  25.  
  26.         (  ) ANIMATED KENO  ($10)
  27.         (  ) WILD BALL KENO  ($10)
  28.  
  29.         (  ) BOTH THE ABOVE  ($15)
  30.  
  31.      SHIPPING CHARGES
  32.      --------------------
  33.      Please add $2.00 for shipping if you live in the United States.
  34.      For shipping to all other countries, please add $4.00 per order.
  35.  
  36.      Amount Enclosed: $_________
  37.  
  38.      Make your check or money order payable to ULTISOFT.
  39.  
  40.      Mail payment and registration form to:    ULTISOFT
  41.                                                PO Box 5015
  42.                                                Central Point, OR 97502
  43.                                                USA
  44.      Payment Method:
  45.                      ___ Check   ___ Money Order   ___ VISA   ___ MasterCard
  46.  
  47.      Credit Card Number #_____ - _____ - _____ - _____   expires ____/____
  48.  
  49.      For credit card orders:  Call 1-800-925-3147 (U.S. and Canada)
  50.                                    1-541-664-1885 (International)
  51.                                    1-541-664-3403 (FAX)
  52.  
  53.      Secure Online Orders:    http://www.ultisoft.com
  54.  
  55.