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         USA Registration form for Modem Init String - Database v2.1
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 Today's Date and Time....: 

 Name.....................: 
 Address..................: 
 Zipcode + Location.......: 
 Country..................: 
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  Send this form (along with your payment) to:  David Silver
                                                InitDoor Registrations
                                                1412 Winterville St
                                                Deltona, FL 32725


  Fax orders (credit cards only) and be faxed to: 904-532-1221

  The following prices apply in the USA/Canada:

  US checks/money orders:    [ ]  $10.00
  Visa:                      [ ]  $12.00
  Master/EuroCards:          [ ]  $12.00


  You can also pay online using either our credit card or
  online checking (USA or Canadian checks) door.

  If paying by credit card, I need the following information:

  *********** ALL CREDIT CARDS WILL BE BILLED IN AMERICAN DOLLARS ***********
            The following information will be needed for processing:

            Username: ___________________________________

            Cardtype: Visa/MasterCard ________

            Cardowner: __________________________________
            (EXACTLY as name appears on card)

            Cardnumber:____-____-____-_____

            Expiration: (00/00): ____

   If you want your key by mail (Include additional $5US for Disk)
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   Disk format : [ ] 3.5"
                 [ ] 5.25"

   If you want your key by "polling" - Fidonet Node number Required
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   Node number : [_____] : [_____] / [_____] . [_____]

   Session pwd : [________]

   My FIDO addresses are:

   1:3618/11 - ZyXEL 28.8/v.32bis.  Open to new callers.
   1:3618/22 - V.FC 28.8/v.32bis.   Open ONLY to subscribing members.

   Please Check One :  [_] I will poll for my key from The Silverado BBS

                       [_] I would like my key crashed to me
                           (Nodes ONLY - NO points!!

   Comments/Bug Reports : _______________________________________________

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  Your registration code will work on all new versions of this program.