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Text File  |  1994-04-20  |  2KB  |  55 lines
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  9.                                      ***EVOCATION APPLICATION FORM***
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  11.    Please fill out the form completely so as to avoid delays in the shipment of your game.
  12. If possible, also indicate a fax number maybe of your office or a friend of yours.
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  15. The undersigned ______________________ wants to receive the complete version
  16. of the "Evocation ‚Ä¢The Final Challenge" video game at the following address:
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  18.                   Name and Surname  ______________________________________
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  20.                                                                      Address  ______________________________________
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  22.                                                                                           _______   ________________________   ____
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  24.                                                            Country  _______________________
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  26.                                                Telephone  _______________________   Fax  _______________________
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  30. I will pay the sum of $20, inclusive of the shipping charges, for delivery by air mail
  31. (so as to reduce your waiting times), through
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  33.                                                       [  ] Credit Card nr.   _  _  _  _  -  _  _  _  _  -  _  _  _  _
  34.                                                                                  (the credit card must belong to the group VISA/MASTERCARD/EUROCARD)
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  36.                                                                                                     Expiry date     ____/____
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  38.                                                                               Belonging to  ________________________________
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  40.                                                                      Born on         ____ /____/________ 
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  43.                                                             [  ] The sum of $20 enclosed with this Form.
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  48. Date _____________________                                                                                                                                                        Signature _____________________
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  52.                                                   DEDALOMEDIA SOFTWARE ENGINEERING
  53.      VIA DON GIUSEPPE LAGO, 52 ‚Ä¢ 35013 CITTADELLA LOC. LAGHI (PD) ‚Ä¢ ITALY
  54.                                                   TELEPHONE +39.49.9422115 ‚Ä¢ FAX +39.49.9422099
  55.                             APPLELINK ITA0749‚Ä¢INTERNET ITA0784@APPLELINK.APPLE.COM