home *** CD-ROM | disk | FTP | other *** search
/ Aminet 33 / Aminet 33 - October 1999.iso / Aminet / docs / anno / XTrace_News01.lha / RegForm_ShareIt_English.txt < prev    next >
Text File  |  1999-07-22  |  2KB  |  54 lines
  1.                   ShareIt! (www.shareit.com) Registration form
  2.                           XTrace - Program No.: 104814
  3. -------------------------------------------------------------------------------
  4.          Please use this form _only_ for registrations via ShareIt! !!
  5. -------------------------------------------------------------------------------
  6.  
  7. Name        : _________________________________________________________________
  8.  
  9. Address     : _________________________________________________________________
  10.  
  11.               _________________________________________________________________
  12.  
  13. Country     : _________________________________________________________________
  14.                 
  15. Phone       : _________________________________________________________________
  16.  
  17. Fax         : _________________________________________________________________
  18.  
  19. e-mail      : _________________________________________________________________
  20.  
  21.  
  22. Hardware    : CPU : [ ] MC68000  [ ] MC68010  [ ] MC68020 [ ] MC68030
  23.                     [ ] MC68040  [ ] MC68060  [ ] PPC603  [ ] PPC604
  24.  
  25.               FPU : [ ] none  [ ] M 68881  [ ] M 68882  [ ] integrated
  26.  
  27. Payment by  : [ ] Cheque
  28.               [ ] Cash   
  29.               [ ] Wire transfer
  30.  
  31.               [ ] Credit card
  32.                   [ ] Visa             [ ] Eurocard/Mastercard
  33.                   [ ] American Express [ ] Diners Club
  34.  
  35.                   Card holder: ________________________________________________
  36.  
  37.                   Card No.: ___________________________________________________
  38.  
  39.                   Date of Expiration : ________________________________________
  40.  
  41.               The registration fee for a registration via ShareIt! is is in
  42.               every case Euro 25.00 or US$ 25.00.
  43.  
  44. Delivery:   [ ] by mail on a branded 3.5" disk
  45.             [ ] by e-mail, UU/MIME (please select) encoded
  46.  
  47.  
  48.  
  49.  
  50.  
  51. ____________________   _______________________________________
  52.         date                          signature 
  53.  
  54.