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REGISTER.TXT
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1998-04-22
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2KB
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49 lines
BLIZZ E-MAIL
REGISTRATION FORM
Print this form and complete it.
Once completed, send it by fax at 514-359-7060 (Canada)
Please write clearly.
NAME: _____________________________________________________
E-MAIL: _____________________________________________________
COMPANY: _____________________________________________________
ADDRESS: _____________________________________________________
_____________________________________________________
CITY: _____________________________________________________
STATE: _____________________________________________________
COUNTRY: _________________________ ZIP CODE: _______________
TELEPHONE: _____________________________________________________
Blizz E-Mail Cost (5 users version):
AMOUNT: 69.99$Can x NUMBER OF COPIES: _____ TOTAL: _________$Can
(note: Depending on exchange rate, 69.99$Can is about 49.99$US)
Payment method: Check ____ TO: BLIZZ INFORMATIQUE
Money order ____ 446, du Blizzard
VISA ____ St-Luc, Qc, CANADA
J2W 1Y4
SIGNATURE: _________________________________________________
Note: For each registration we will contact you by e-mail.
FOR VISA PAYMENT:
=================
NUMBER: _________________________ EXPIRY DATE:________
NAME ON THE CARD: ______________________________________________