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  1. *****************************************************************************
  2.  
  3.              WRAITH Version 3.0 - Order Form
  4.  
  5. *****************************************************************************
  6.  
  7. First Name:  _______________________________________________________
  8.  
  9. Last Name:   _______________________________________________________
  10.  
  11. Address:     _______________________________________________________
  12.  
  13. City:        _______________________________________________________
  14.  
  15. State:       _______________________________________________________
  16.  
  17. Country:     _______________________________________________________
  18.  
  19. Zip Code:    _______________________________________________________
  20.  
  21. Phone #:     _______________________________________________________
  22.  
  23. *****************************************************************************
  24.  
  25. Registration:           $17.00                              ________
  26.  
  27. Shipping:               $ 3.00                              ________
  28.  
  29. Total:                                                      ________
  30.  
  31.     ( Note: It should only take a week for delivery!)
  32.  
  33. *****************************************************************************
  34.  
  35. Please tell us how you obtained this program. It will help us to bring you
  36. updates and future programs more quickly:
  37.  
  38.     ____ CompuServe      ____ America On-Line   ____ Prodigy
  39.     ____ ZiffNet         ____ Friend
  40.     ____ Local BBS, please specify name & phone number:
  41.          ______________________________________________________________
  42.     ____ Catalog/Shareware CD, please specify name:
  43.  
  44.          ______________________________________________________________
  45.  
  46. *****************************************************************************
  47.                 Robert J. Deutsch
  48.           1152 N. 14th St. * Allentown * Pennsylvania * 18102
  49.                  (610) 434-0723
  50. *****************************************************************************
  51.