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Text File  |  1992-10-11  |  5KB  |  62 lines
  1. +-----------------------------------------------------------------------------+
  2. | DUNGEONS OF DRAKKLOR v4.0 Registration Form (1A)    Date:    /   /          |
  3. +-----------------------------------------------------------------------------+
  4. |                    Specify diskette size  [ ] 3.5" [ ] 5.25"                |
  5. +------------------------------------+----------------------------------------+
  6. | Mail your orders/responses to:     | [ ]  $14.95 Basic Registration         |
  7. |                                    |                                        |
  8. |     WestWorld Computer Services    | [ ]  $ 3.00 Printed Map Booklet        |
  9. |     3755 Avocado Blvd.             |             (only with registration)   |
  10. |     Suite 304                      | [ ] (     ) CA res. 7.75% sales tax    |
  11. |     La Mesa, CA  91941-7301        |                                        |
  12. +------------------------------------+ [ ]  $ 3.00 Shipping - All orders      |
  13. | FAX orders only (no responses) to: |                                        |
  14. |                                    | [ ]  $ 5.00 Additional handling charge |
  15. |     (619) 558-2225 (24 hours)      |             for orders outside the USA |
  16. +------------------------------------+             and Canada.                |
  17. | To order by phone call:            |                                        |
  18. |                                    | ================                       |
  19. |     (800) 995-1605 (24 hours)      | |              |  Total enclosed       |
  20. +------------------------------------+ ================                       |
  21. | Outside of the US call:            |                                        |
  22. |                                    |    ** All payments must be in US **    |
  23. |     (619) 685-7291 (24 hours)      |    ** funds drawn on a US Bank   **    |
  24. +------------------------------------+----------------------------------------+
  25. | METHOD OF PAYMENT: All prices are in US Dollars. Please include applicable  |
  26. |                    taxes and shipping cost.                                 |
  27. |                                                                             |
  28. | [ ] Check/Money Order (payable to WestWorld Computer Services)              |
  29. | [ ] Visa  [ ] Master Card                                                   |
  30. |                                                                             |
  31. |          |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |  |          |  |  | |
  32. | Account# |--|--|--|--|--|--|--|--|--|--|--|--|--|--|--|--| Exp Date |--|--| |
  33. |                                                                             |
  34. | Authorized Signature                                                        |
  35. |                     ------------------------------------------------------  |
  36. | Daytime Phone                                                               |
  37. |                     ------------------------------------------------------  |
  38. |                     (Signature and phone required for credit card orders)   |
  39. +-----------------------------------------------------------------------------+
  40. | SHIP TO NAME/ADDRESS (please print)  | BILL TO NAME/ADDRESS (if different)  |
  41. |                                      |                                      |
  42. | ------------------------------------ | ------------------------------------ |
  43. |                                      |                                      |
  44. | ------------------------------------ | ------------------------------------ |
  45. |                                      |                                      |
  46. | ------------------------------------ | ------------------------------------ |
  47. |                                      |                                      |
  48. | ------------------------------------ | ------------------------------------ |
  49. +-----------------------------------------------------------------------------+
  50. |                   | National BBS Name/Forum  :                              |
  51. |                   +---------------------------------------------------------+
  52. | Where did you get | Local BBS          Name  :                              |
  53. | get your copy of  |            City / State  :                              |
  54. |   DUNGEONS OF     |                    Tel#  :                              |
  55. |    DRAKKLOR?      +---------------------------------------------------------+
  56. |                   |        Distributor Name  :                              |
  57. |                   +---------------------------------------------------------+
  58. |                   | Friend / Associate (Y/N) :                              |
  59. +-----------------------------------------------------------------------------+
  60. | All registered users will automatically be entered in our software drawings |
  61. +-----------------------------------------------------------------------------+
  62.