CCol Shareware Registration (01/95) ========================================================================= The following information is used in the creation of your individual KEY file, and **MUST** match your MAKEWILD configuration, EXACTLY, or the KEY will not work (typing is Recommended to prevent mistakes!): BBS NAME: ________________________________________________ SYSOP NAME: ______________________________________________ WILDCAT REGISTRATION NUMBER: _____________________________ ^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^^ NOTE! BE SURE THIS INFORMATION MATCHES YOUR MAKEWILD CONFIGURATION EXACTLY. CAPITALIZATION / PUNCTUATION IS CRITICAL! ========================================================================= Your Name: _______________________________________________ Address: _________________________________________________ City: ____________________________________________________ State: _____ Zip Code: ___________ Birthdate: ____ / ____ / ____ Please Select a Password: ________________ Voice Phone: ______________________________ BBS Phone: ________________________________ Social Security Number:___________________________________ (SSN REQUIRED if you are using On-Line Credit Card or Check Payment Options. It will be used to validate your transaction! International registrations: Provide your citizenship ID Number for your country) ========================================================================== Shareware Registrations: (all funds are US) [ ] wcSECURE, the Professional Sysops Choice for BBS Security $21.00 [ ] wcSPY, the callers choice to see who's on-line $ 7.00 [ ] wcAlias, the fast and easy WC! Alias name changer $ 7.00 INDICATE TOTAL: $[ ] ========================================================================== Special Offers: (download latest versions from CCol!) 1. Order all 3 and pay only $25.00! 2. Order wcSECURE and get wcSPY FREE! 3. Get wcSPY and wcAlias together, pay only $10.00! (offers may not be combined. Not valid with any other offer) ========================================================================== Select your Method of Payment: [ ] Check / Money Order (Enclosed) [ ] VISA or MASTERCARD ** ** Complete the following for Credit Card Transactions: ** ISSUING BANK: _______________________________________________ ** CARD NUMBER: ________________________________________________ ** NAME AS IT APPEARS ON THE CARD: _____________________________ ** EXPIRATION DATE: ____ / ____ ** X____________________________________________________ (online orders place SSN above in place of signature) Signature above authorizes Capital City On-Line to charge the account noted above for the purpose of registering shareware. Signature is the card holder of the account, in accordance with the terms of the card holder agreement. =========================================================================== Payment Options: 1. On-Line using a Credit Card 2. On-Line using a Check (US ORDERS ONLY) 3. Mailing in a check or money order 4. Mailing in the form with your credit card information Options 1 & 2 Instructions: ----------------------------------------------------------------------- Call CCol at 1-360-956-0408, log in as a new user, unless you've called us before. Leave a comment to the sysop, and upload this form via TEXT IMPORT into your message. Credit card orders will be processed from the information above. For check orders select K (Check Orders) from the Main Menu and follow the on screen instructions. Your key will normally be posted within 24 hours. Options 3 & 4 Instructions: ----------------------------------------------------------------------- Mail the completed form, with your choice of payment. Checks payable to Capital City On-Line: Capital City On-Line 800 Sleater Kinney SE #176 Lacey, WA 98503