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|00000000| 00 22 05 4e 61 6d 65 3a | 08 41 64 64 72 65 73 73 |.".Name:|.Address|
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|00000030| 20 5a 69 70 3a 08 43 6f | 75 6e 74 72 79 3a 0a 54 | Zip:.Co|untry:.T|
|00000040| 65 6c 65 70 68 6f 6e 65 | 3a 06 45 6d 61 69 6c 3a |elephone|:.Email:|
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|00000070| 47 65 6e 69 65 06 44 65 | 6c 70 68 69 08 49 6e 74 |Genie.De|lphi.Int|
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|00000090| 24 31 30 2e 30 30 0f 50 | 72 69 63 65 20 70 65 72 |$10.00.P|rice per|
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|000000d0| 6e 74 20 44 75 65 3a 15 | 50 6c 65 61 73 65 20 63 |nt Due:.|Please c|
|000000e0| 68 61 72 67 65 20 6d 79 | 20 56 69 73 61 1b 50 6c |harge my| Visa.Pl|
|000000f0| 65 61 73 65 20 63 68 61 | 72 67 65 20 6d 79 20 4d |ease cha|rge my M|
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|00000110| 6b 20 6f 72 20 6d 6f 6e | 65 79 20 6f 72 64 65 72 |k or mon|ey order|
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|000001b0| 72 74 69 6e 67 20 73 68 | 61 72 65 77 61 72 65 21 |rting sh|areware!|
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|000001d0| 77 69 74 68 20 70 61 79 | 6d 65 6e 74 20 74 6f 3a |with pay|ment to:|
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|00000270| 20 28 35 30 33 29 20 37 | 34 36 2d 30 37 37 31 2e | (503) 7|46-0771.|
|00000280| fa 45 6d 61 69 6c 20 74 | 68 69 73 20 66 6f 72 6d |.Email t|his form|
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|00000330| 70 68 69 20 61 72 65 20 | 63 68 65 63 6b 65 64 20 |phi are |checked |
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