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  1.                                 ORDER FORM
  2.                       VBSYX 2.2 and XG/GS MIDI Jukebox
  3.          FOR AUSTRALIAN AND INTERNATIONAL (NON-USA, NON-UK) ORDERS
  4.          =========================================================
  5.  
  6.  
  7.     Name:                             _________________________________
  8.  
  9.     Company/Address:                  _________________________________
  10.  
  11.                                       _________________________________
  12.  
  13.                                       _________________________________
  14.  
  15.     Your Telephone Number:            _________________________________
  16.                                          (include area/country code)
  17.  
  18.  
  19.     Your E-Mail Address:    ___________________________________________
  20.                                   (Must be reachable via Internet)
  21.  
  22.                              Registration Name
  23.       (Capitalization and Punctuation will be used exactly as listed)
  24.       ---------------------------------------------------------------
  25.  
  26.  
  27.     Your Name (required):             _________________________________
  28.  
  29.  
  30.     Price Calculation
  31.     -----------------
  32.  
  33.     Registration Fee: $24.95 AUD per copy
  34.  
  35.  
  36.     Registration Fee: _____ copies @ $24.95 AUD each = ___________
  37.  
  38.     Total Cost:                                        ___________
  39.  
  40.  
  41.     Checks or Money orders:  Make payable in Australian currency on an
  42.                              Australian bank.
  43.                              DO NOT SEND CASH!!!!!
  44.  
  45.     Send this entire form with your check or money order (again, no cash)
  46.     payable to Mike Le Voi to the following address:
  47.  
  48.                           Mike Le Voi
  49.                           33 Pleasant Drive
  50.                           ALBANY CREEK
  51.                           QLD 4035
  52.                           AUSTRALIA
  53.  
  54.     Please allow 6-8 weeks for delivery of mailed registration keys, and
  55.     5-10 days for delivery of keys via e-mail.
  56.  
  57.  
  58.     How did you receive your copy of VBSYX and/or XG/GS MIDI Jukebox?
  59.  
  60.     [ ] CompuServe
  61.  
  62.     [ ] America Online
  63.  
  64.     [ ] Prodigy
  65.  
  66.     [ ] FidoNet (please list node)  ______________________________________
  67.  
  68.     [ ] World Wide Web site or FTP site  _________________________________
  69.  
  70.     [ ] Other BBS  _______________________________________________________
  71.  
  72.     [ ] Catalog __________________________________________________________
  73.  
  74.     [ ] Other ____________________________________________________________
  75.  
  76.  
  77.  
  78.     Do you have any comments or suggestions?
  79.  
  80.  
  81.     ______________________________________________________________________
  82.  
  83.     ______________________________________________________________________
  84.  
  85.     ______________________________________________________________________
  86.  
  87.     ______________________________________________________________________
  88.  
  89.     ______________________________________________________________________
  90.  
  91.     ______________________________________________________________________
  92.  
  93.     ______________________________________________________________________
  94.  
  95.  
  96.     Thank you for ordering VBSYX and XG/GS MIDI Jukebox!
  97.  
  98.  
  99.