FoneALIVE! Wide Area Beta tester registration questioneer

 
    This program licenses you to use the prototype version of FoneALIVE!
    until the production version of the device is released. At that time you
    may exchange the prototype device for the production device, for $15.00
    handling fee. The prototype device may not be passed to a third party
    at any time or for any reason. The prototype device remains the property
    of Access Solutions Corporation. The production device is your property
    which you may sell, trade or barter as you please.
 
    If you are interested in joining the Beta test program, the fee is
    $179.00 + $15.00 shipping and handling. This is a limited time offer and
    includes upgrade to the production version as specified above. There
    will be a limit of two Beta (prototype) units per customer. The 
    prototype devices will be shipping late August 1994, subsequent to
    receipt of payment. Payment may consist of money orders or personal/
    business checks. Credit cards are not accepted for this program.
 
What is your First and Last name?____________________________________________

What is your business name?__________________________________________________

What is your street address (line1)?_________________________________________

What is your street address (line2)?_________________________________________

What is your city?___________________________________________________________

What is your state?_____________________What is your Zip code?_______________

What is your day voice number include area code?_____________________________

What is your FAX number include area code?___________________________________

What is your data number include area code?__________________________________

What type of device will you use FoneALIVE! with?____________________________

_____________________________________________________________________________

Signature (required)_________________________________________________________

Mail to:  Access Solutions Corporation     Voice: 609-988-8007
          402 Westerly Drive               Fax:   609-988-8664 
          Marlton, NJ 08053                BBS:   609-988-1717