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Text File  |  1991-11-22  |  2KB  |  59 lines
  1.       ActaeOn Version 2.0                          US Registration Form
  2.       -----------------------------------------------------------------
  3.         Make checks payable to:
  4.           Shareable Software International
  5.           P.O. Box 59102
  6.           Schaumburg           Credit Card registrations accepted
  7.           IL  60159            Telephone  : 800-622-2793 (Orders only)
  8.                                           : 708-397-1221 (Inquiries)
  9.                                Fax        : 708-397-0381
  10.       -----------------------------------------------------------------
  11.       Quan       Item                             Price       Total
  12.  
  13.       ___  ActaeOn registration   ............... @ $39.95    ________
  14.  
  15.       ___  Shipping and handling   .............. @  $4.00    ________
  16.  
  17.            Sales Tax (Illinois residents only) .. @     7%    ________
  18.  
  19.  
  20.                                                       Total   ________
  21.  
  22.       Checks or money orders in US dollars or Visa/Master Card accepted.
  23.       -----------------------------------------------------------------
  24.        Check enclosed ____ Visa ____ Master Card ____ (tick as approp.)
  25.  
  26.         Name on Card ________________________________________________
  27.  
  28.         Card Number ________________________________ Expires ________
  29.  
  30.  
  31.         Media 5.25" [  ]   3.5" [  ]     (Tick as appropriate)
  32.  
  33.           Name_______________________________________________________
  34.  
  35.        Company_______________________________________________________
  36.  
  37.        Address_______________________________________________________
  38.  
  39.               _______________________________________________________
  40.  
  41.               _______________________________________________________
  42.  
  43.          Phone_________________________  Bus.________________________
  44.  
  45.       Where did you obtain ActaeOn? _________________________________
  46.  
  47.       ActaeOn Serial Number   _______________________________________
  48.  
  49.       Comments_______________________________________________________
  50.  
  51.               _______________________________________________________
  52.  
  53.               _______________________________________________________
  54.  
  55.       What other shareware products would you be interested in?
  56.  
  57.       -----------------------------------------------------------------
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