UNITED KINGDOM ORDER FORM
                         ~~~~~~~~~~~~~~~~~~~~~~~~~

Credit card orders only. Visa or Mastercard.

To register send payment/order to our local agent:

	ENSIGN SYSTEMS
	21 Tredown Road
	Sydenham
	LONDON SE26 5QQ

	Credit card order Line: 0181-778-2871

	Fax order Line: 0181-778-2871

	Email:  ensignpub@aol.com

	Web site: http://www.ensignpub.com

Please provide the following information:

Name_____________________________________

Address_____________________________________________________________________

Address_____________________________________________________________________

City___________________ State/Prov.______________Zip/Postal Code____________

Country_____________________________________________________________________

E-Mail (if any)____________________

Fax (if any)_______________________  Phone (optional)_______________________


PELLENC's Products:
~~~~~~~~~~~~~~~~~~

[ ] Bomb Golf License at £9.99		_________

[ ] 32 Card Bridge License at £12.95	_________

[ ] Hockey Pong License at £9.99	_________

    + Shipping:	Code only: FREE	 	
		Disks: £2.00		_________

			TOTAL		_________


Payment Method:
~~~~~~~~~~~~~~

VISA ____ 	MasterCard  ____ 

Name exactly as on credit card _________________________________

Credit Card #_______________________________________ Expiration Date__________


Signature ___________________________________________
(Only required for mail in and FAX credit card orders)

Thank you for registering.