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Text File  |  1989-04-04  |  4KB  |  54 lines
  1.             +----------------------------------------------------------+
  2.             |            ScreenPaint 1.0 Registration Form             |
  3.             +----------------------------------------------------------+
  4.             |                                                          |
  5.             | Send to:            Kai Laurinolli                       |
  6.             |                     2970 Mira Place                      |
  7.             | $25 US              Burnaby, B.C.                        |
  8.             | $32 Cdn             V3J-1B6  Canada                      |
  9.             |                                                          |
  10.             +----------------------------------------------------------+
  11.             |                                                          |
  12.             |                                                          |
  13.             | Name: _________________________________________________  |
  14.             |   (Last)             (First)              (Initial)      |
  15.             |                                                          |
  16.             |                                                          |
  17.             | Company: ______________________________________________  |
  18.             |                                                          |
  19.             |                                                          |
  20.             |                                                          |
  21.             | Address: ______________________________________________  |
  22.             |                                                          |
  23.             |                                                          |
  24.             |                                                          |
  25.             | City: ___________________ State/Province: _____________  |
  26.             |                                                          |
  27.             |                                                          |
  28.             |                                                          |
  29.             | Zip/Postal Code: _________________ Country: ___________  |
  30.             |                                                          |
  31.             |                                                          |
  32.             |                                                          |
  33.             | Phone: (     )_____-________ Fax: (     )_____-________  |
  34.             |                (Optional)                 (Optional)     |
  35.             |                                                          |
  36.             |                                                          |
  37.             | Date: _____/_____/_____   Amount Enclosed: ____________  |
  38.             |        (M)   (D)   (Y)                                   |
  39.             +----------------------------------------------------------+
  40.             | Your comments, ideas for future versions, and complaints |
  41.             | are welcomed:                                            |
  42.             |                                                          |
  43.             |                                                          |
  44.             |                                                          |
  45.             |                                                          |
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  48.             |                                                          |
  49.             |                                                          |
  50.             |                                                          |
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  52.             |                                                          |
  53.             +----------------------------------------------------------+
  54.