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Text File  |  1992-12-12  |  1KB  |  54 lines
  1.              DiskTrak for Windows Order Form
  2.              ===============================
  3.  
  4.    Name: _______________________________________________
  5.  
  6. Company: _______________________________________________
  7.  
  8. Address: _______________________________________________
  9.  
  10.          _______________________________________________  
  11.  
  12.    City: _______________________________   State: ______   
  13.  
  14. Country: _________________  ZIP/Postal Code: ___________
  15.  
  16.  
  17. Method of payment:
  18.  
  19.  
  20.        ____ check for $25.00 (US) made payable to Peninsula Software 
  21.  
  22.  
  23.        ____ Visa or MasterCard credit card ($27.50 total)
  24.  
  25.             Note: Visa/MasaterCard orders are acceptable, but Peninsula
  26.                   Software must charge a bank processing fee of $2.50 
  27.                   for all credit card orders.
  28.  
  29.            Credit Card type:  ____ Visa    ____ Mastercard
  30.  
  31.            Credit Card Number: ___________________________
  32.  
  33.            Expiration Date: _______________
  34.  
  35.            Signature: _____________________  Date: ______________
  36.          
  37.  
  38.  
  39. Comment: _________________________________________________
  40.  
  41.          _________________________________________________
  42.  
  43.          _________________________________________________
  44.  
  45.  
  46.  
  47. Send to:     Peninsula Software
  48.              28510 Blythewood Drive
  49.              Palos Verdes CA 90274
  50.  
  51.  
  52.  
  53.          -----> Thank you for supporting shareware <-----
  54.