home *** CD-ROM | disk | FTP | other *** search
/ Creative Computers / CreativeComputers.iso / shareware / graphics / imagedex / registration < prev    next >
Text File  |  1994-11-17  |  2KB  |  60 lines
  1.  
  2.                               ImageDex Registration
  3.  
  4.                Send to:       Precision Imagery
  5.                               P.O. Box 20676
  6.                               Cranston, RI 02920
  7.                               USA
  8.  
  9. ------------------------------- Cut here 8< -------------------------------
  10.  
  11.  
  12.  
  13. ______    ImageDex Registration fee............. @ US$10.00 ea. $ _________
  14.  
  15.  
  16.           SHIPPING & HANDLING  
  17.  
  18.           North America: $1;   Outside: $3                      $ _________
  19.  
  20.  
  21.  
  22.                                                        SUBTOTAL $ _________
  23.  
  24.  
  25.  
  26.          Rhode Island residents add Sales Tax......@ 7% (ouch!) $ _________
  27.  
  28.  
  29.  
  30.                         TOTAL (U.S. funds drawn on a U.S. bank) $ _________
  31.  
  32.  
  33.  
  34. Name: _____________________________________________________________________
  35.  
  36. Company (ONLY if company address): ________________________________________
  37.  
  38. Address: __________________________________________________________________
  39.  
  40.          __________________________________________________________________
  41.  
  42.          __________________________________________________________________
  43.  
  44.   Phone: _________________________
  45.  
  46.  
  47.  
  48. Problems, bugs, compliments, suggestions, flames: _________________________
  49.  
  50. ___________________________________________________________________________
  51.  
  52. ___________________________________________________________________________
  53.  
  54. ___________________________________________________________________________
  55.  
  56. ___________________________________________________________________________
  57.  
  58.  
  59.  
  60.