Artishock, Inc., Order Form

Mail this Form along with your payment to:

Artishock, Inc.
520 Madison Ave., 38th Floor
New York, NY 10022
USA

Billing Address:

Name:     ___________________________
Address:  ___________________________
City:     ___________________________   State/Prov.: _____________
Zip:      ___________________________   Country:     _____________
Tel.:     ___________________________   

I would like to receive my registration number by e-mail:  Yes / No

E-Mail:   ___________________________

Ship To (if different from billing address):

Name:     ___________________________
Address:  ___________________________
City:     ___________________________   State/Prov.: _____________
Zip:      ___________________________   Country:     _____________

Products (Circle all that apply):

Product       Version              Key Code   Item Price    Total   
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Koohg        1.0.4 for Windows      ______      $19.95      $______ 

Strategram   1.0.4 for Windows      ______      $24.95      $______

-------------------------------------------------------------------

Grand Total:    $ ___________

Method of Payment (Check One):

__   Cheque   __   Money Order


Thank you for your order!