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Text File  |  1994-06-10  |  1KB  |  53 lines
  1.  
  2.  
  3.                                 Registration Form
  4.  
  5.  
  6. Registration entitles the user full support and the newest version of Casino
  7. Keno.
  8.  
  9. Disk Size          ( ) 3.5         ( ) 5.25
  10.  
  11. Registration                                        $ 10.00
  12.  
  13. Shipping/Handling                                   $  1.50
  14.  
  15. Foreign orders add $3.00                            $______
  16.  
  17. ***All Orders must be in U.S. funds***
  18.  
  19. Total                                               $______
  20.  
  21.  
  22.  
  23. ***Make checks payable to Paul Herrmann
  24.  
  25. Send to:        Paul Herrmann
  26.             814 Niagara St.
  27.             Waukesha, WI 53186-3816
  28.  
  29.  
  30. Name___________________________________________________________________________
  31.             first                            last
  32.  
  33.  
  34. Address________________________________________________________________________
  35.  
  36.  
  37. City____________________________________State__________Zip_____________________
  38.  
  39.  
  40. Country__________________
  41.  
  42.  
  43. ***To help me plan other programs please provide the following information:
  44.  
  45. Where was this program obtained________________________________________________
  46.  
  47. What Type of system do you own(286,386,etc.)___________________________________
  48.  
  49. Video Display(Ega,Vga,Svga,etc.)_______________________________________________
  50.  
  51. Mouse     ( )Yes  ( )No
  52.  
  53. Joystick  ( )Yes  ( )No