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  1.  
  2.                 REAL VIDEO POKER for Windows 95 REGISTRATION
  3.  
  4.           Name        ____________________________________________
  5.  
  6.           Company     ____________________________________________
  7.  
  8.           Address     ____________________________________________
  9.  
  10.           City/State  ____________________________________________
  11.  
  12.           Zip Code    _________  Country _________________________
  13.  
  14.           Phone      (    ) ____-______  EMail ___________________
  15.  
  16.          EMail       _____________________________________________
  17.  
  18.      DISK SIZE:  (  ) 3-1/2" Diskette     (  ) CD-ROM Disc
  19.  
  20.      I AM ORDERING:
  21.               (  ) REAL Video Poker (ú14)
  22.               (  ) REAL Video Poker and REAL Video Blackjack (ú17)
  23.               (  ) REAL Video Poker & BJ and Noisy Video Poker & BJ (ú21)
  24.  
  25.      POSTAGE & PACKING
  26.      -----------------
  27.      Please add ú3 for postage charges if you would like us to send the software
  28.      to you.  If you already have the software and only require the registration
  29.      code, then there is no additional P&P fee.
  30.  
  31.      Amount Enclosed: $_________
  32.  
  33.      Make your check or money order payable to GAMESCAPE STUDIOS.
  34.  
  35.      Mail payment and registration form to:    GAMESCAPE STUDIOS
  36.                                                Egloshayle
  37.                                                Wadebridge
  38.                                                Cornwall
  39.                                                PL27 6AX
  40.                                                UNITED KINGDOM
  41.      Payment Method:
  42.                      ___ Check   ___ Money Order   ___ VISA   ___ MasterCard
  43.  
  44.      Credit Card Number #_____ - _____ - _____ - _____   expiry ____/____
  45.  
  46.      For credit card orders:  Call 01208 816323 (Orders and Information)
  47.                                    01208 816006 (FAX)
  48.  
  49.      Order Online at:         http://www.gamescapestudios.com/order.htm
  50.  
  51.