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Text File  |  1995-12-11  |  2KB  |  55 lines
  1.            REGISTRATION INVOICE FOR HIDIMG (C) v3.0 SHAREWARE
  2.            ▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀▀
  3. Make all checks/money orders out to or call with credit card order:
  4.  
  5.                      FHS Supply Inc.
  6.                      PO Box 9
  7.                      Clover, SC 29710
  8.                      USA
  9.                      Voice: 1-800-742-8484  or  1-803-222-7488
  10.                      24-hour FAX: 1-803-222-7285
  11.  
  12. Please fill out the form below:
  13.  
  14. Name:______________________________________________________________
  15.  
  16. Company:___________________________________________________________
  17.  
  18. Address:___________________________________________________________
  19.  
  20. City:__________________________ State:__________ Zip:______________
  21.  
  22. Country:_______________________ Telephone #:_______________________
  23.  
  24. EMail Address:_____________________________________________________
  25.  
  26. Version # of HIDIMG you are currently using:_______________________
  27.  
  28. Where did you obtain your copy of HIDIMG?__________________________
  29.  
  30. Prices are shown in US Dollars. Please ensure that your check is in
  31. US Dollars, drawn on a US bank.  Checks will be held until cleared.
  32.  
  33. Disk Size:  _____ (5 1/4" 1.2M)      _____ (3 1/2" 1.44M)
  34.  
  35. Quantity                          Price Ea.        Total
  36.  
  37. _______  HIDIMG v3.0 Program      $35.00           $_____
  38.                  or
  39. _______  HIDIMG v2.1 Program      $24.95           $_____
  40.  
  41. _______  Spirograph Program        $5.00           $_____
  42.  
  43.          Shipping & Handling                       $ 5.00
  44.  
  45. SC Residents add 5% sales tax       Total Enclosed:$_____
  46.  
  47. Credit Card Orders ( VISA / MasterCard / Discover / American Express )
  48.  
  49. NAME ON CARD:___________________________________________
  50.  
  51. Card #:_________________________________________________
  52.  
  53. CARD EXPIRATION DATE:___________________________________
  54.  
  55. Authorizing Signature:__________________________________