58 lines
1.6 KiB
Plaintext
58 lines
1.6 KiB
Plaintext
Registration Form
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EMAIL ADDRESS:___________________________________________
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NAME:____________________________________________________
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ADDRESS:_________________________________________________
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_________________________________________________
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_________________________________________________
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CITY:________________________ STATE:____ ZIP:____________
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COUNTRY:____________
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PHONE # (Data): ___ ____ ______________
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(Voice): ___ ____ ______________
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General info:
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Machine type: 8088/6[_] 80286[_] 80386[_] 80486[_] Other[_]
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Machine name: ________________________________________
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Display type: MDA[_] CGA[_] Herc[_] EGA[_] MCGA[_] VGA[_] SVGA[_]
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Card name:_____________________________________________
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Floppy drives: 3« 720k[_] 3« 1.44M[_] 3« 2.88M[_]
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5¬ 360k[_] 5¬ 1.2M [_]
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Modem speed: 1200[_] 2400[_] 4800[_] 9600[_] 19200[_] Other: ________
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Modem name:_____________________________
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Other configuration:_________________________________________________
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_________________________________________________
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_________________________________________________
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_________________________________________________
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_________________________________________________
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Driver type: Svga 256 ____ @ $20
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Svga 16 ____ @ $20
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Tweak 256 ____ @ $20
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Tweak 16 ____ @ $30
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Two drivers ____ @ $30 (check above)
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Four drivers ____ @ $50
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Do you want a copy of the source? _____
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From September 1-May 8, please send checks/money to:
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Jordan Hargrave
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1000 Morewood Ave, Box #3277
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Pittsburgh, PA 15213
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(412) 268-4493
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From May 8-September 1, send to:
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Jordan Hargrave
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1615 Burnley Road
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Charlotte, NC 28210
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(704) 553-2332
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