	Shareware Registration/ Product Order Form
P.O. Box 4503

Overland Park, KS 66204-0503

Please place a check mark next to the item that

you are registering. Insert the price if you want the

product to be mailed to you via U.S. mail.

v	Name	Price
	Dicey, Version 1	$12.00
	subtotal
	Add $3.00 for CD
	Add $2.00 for 3½” diskette
	Total remitted

Please send check or money order (cash at your own risk), please.

Credit cards are not accepted at this time.

Upon receipt and clearance of the payment, I will send the registered version to you,

via your choice of methods.

If you want the products e-mailed to you, please include that e-mail address below:

This e-mail address will be used for distribution of registered products, updated versions,

and notifications of new products. It will NOT be released to anyone outside this organization.

If you want the products mailed via U.S. mail, please include the shipping address below:

Name

Address

Address

City, State, Zip

We thank you for your registration and your patronage.