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  1.                                 ORDER FORM
  2.                       VBSYX 2.2 and XG/GS MIDI Jukebox
  3.                           FOR UNITED KINGDOM 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: £12 (UK pounds) per copy
  34.  
  35.  
  36.     Registration Fee: _____ copies @ £12 each        = ___________
  37.  
  38.     Total Cost:                                        ___________
  39.  
  40.  
  41.     Cheques or Money orders:  Make payable in UK currency on a UK bank.
  42.                               DO NOT SEND CASH!!!!!
  43.  
  44.     Send this entire form with your cheque or money order (again, no cash)
  45.     payable to Martin Le Voi to the following address:
  46.  
  47.                           Martin Le Voi
  48.                           31 Buckingham Gate
  49.                           EAGLESTONE
  50.                           MILTON KEYNES
  51.                           BUCKS MK6 6AA
  52.  
  53.     Please allow 6-8 weeks for delivery of mailed registration keys, and
  54.     5-10 days for delivery of keys via e-mail.
  55.  
  56.  
  57.     How did you receive your copy of VBSYX and/or XG/GS MIDI Jukebox?
  58.  
  59.     [ ] CompuServe
  60.  
  61.     [ ] America Online
  62.  
  63.     [ ] Prodigy
  64.  
  65.     [ ] FidoNet (please list node)  ______________________________________
  66.  
  67.     [ ] World Wide Web site or FTP site  _________________________________
  68.  
  69.     [ ] Other BBS  _______________________________________________________
  70.  
  71.     [ ] Catalog __________________________________________________________
  72.  
  73.     [ ] Other ____________________________________________________________
  74.  
  75.  
  76.  
  77.     Do you have any comments or suggestions?
  78.  
  79.  
  80.     ______________________________________________________________________
  81.  
  82.     ______________________________________________________________________
  83.  
  84.     ______________________________________________________________________
  85.  
  86.     ______________________________________________________________________
  87.  
  88.     ______________________________________________________________________
  89.  
  90.     ______________________________________________________________________
  91.  
  92.     ______________________________________________________________________
  93.  
  94.  
  95.     Thank you for ordering VBSYX and XG/GS MIDI Jukebox!
  96.  
  97.  
  98.