Registration Form for PCB-Net v7.1 for PCBoard 15.0-15.2

Sysop Name:______________________________________________(Print Clearly Please)
BBS Name  :______________________________________________(Print Clearly Please)
BBS Phone :______________________________________________(Print Clearly Please)
Home Phone:______________________________________________(Print Clearly Please)

Password to Use On BBS:__________________________________(Print Clearly Please)

Registration is welcomed by: personal check, or money order, or credit card!

Registration is also welcomed by: VISA, MasterCard, Diners Club,Carte Blanche,
or JCB cards. For all credit card orders shipping and handling will be
automatically added to the initial registration cost.

[ ] Enclosed is $13.00 for the Registered Version of PCB-Net v7.1 [CHECK/MO)

[ ] Bill my Credit Card below for $13.00

[ ] VISA, [ ] MasterCard, [ ] Diners Club, [ ] Carte Blanche, [ ] JCB

Card Number:____________________________________ Expiration Date:_____________ 

Card Holder's Signature REQUIRED:_____________________________________________ 
                                          


Shipping Address:_____________________________________________                 
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Make Checks Payable to:

Cam DeBuck Software
P.O. Box 19
Springville, UT  84663

If you have any comments, please let me know:
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*DO NOT SEND CASH -- Please use a Check or a Money Order *
* If you are Registering outside the U.S. or Canada, please be sure to send
* your Registration Money in U.S. Currency Funds (Money Order in U.S. Funds)

For Technical/Ordering   call (801)785-7012 [Tues-Friday 1pm-6pm]
For BBS Support/Ordering call (801)785-6286 or 801-785-6190 [HST DS 16.8K]