home *** CD-ROM | disk | FTP | other *** search
/ Multimedia Clips / SelectSoftPublishing-StockClips-MultimediaClips-WinMac.bin / PROGRAM / 612QUIT.Dxr / 00003_Field_form printout.txt < prev    next >
Text File  |  1998-01-23  |  2KB  |  43 lines
  1. Product Registration  #MMT610SOUNDS-1
  2.  
  3. Return this form to receive upgrades, discounts and new product information. Mail to: Arc Media Inc., 5330 Main Street #210, Buffalo, NY 14221-5360, fax to:  (416) 410-9651 or web site: www.arcmedia.com
  4.  
  5. Name: ______________________________________________________________
  6.  
  7. Age: ______________ Occupation: _______________________________________
  8.  
  9. Street: _____________________________________________________________
  10.  
  11. City: ___________________________________ State: ______________________
  12.  
  13. Country: ________________________ Zip/Postal Code: ______________________
  14.  
  15. Telephone: ___________________________ Fax: ___________________________
  16.  
  17. E-mail: _____________________________________________________________
  18.  
  19. Computer Type:    [  ] Macintosh    [  ] Windows 3.1    [  ] Windows 95    [  ] OS/2
  20. Please rate this product:    [  ] Excellent    [  ] Good    [  ] Poor
  21.  
  22. Comments: __________________________________________________________
  23.  
  24. ___________________________________________________________________
  25.  
  26. ORDER FORM
  27.  
  28. Title Name                                                                                  Part #                Qty
  29.  
  30. 1 ______________________________________________    ___________    ___
  31.  
  32. 2 ______________________________________________    ___________    ___
  33.  
  34. 3 ______________________________________________    ___________    ___
  35.  
  36. Order paid by:    [  ] Check   [  ] Money order    [  ] MasterCard    [  ] Visa    [  ] Amex
  37.  
  38.     Credit Card #: ____________________ Name: ____________________________  
  39.  
  40.     Expiry date: ___________________ Signature: ___________________________
  41.  
  42. Please make check or money order payable to ARC MEDIA INC.
  43. [  ] Please send me a free catalog