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  1.                         Tosh Gaming Corporations
  2.                         Multi-Media Presenter
  3.  
  4. Name____________________________________________
  5.  
  6. Address_________________________________________
  7.  
  8.        _________________________________________
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  10. Phone Number_(    )_____________________________
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  12. Would you like to receive advanced copies of all of our new software
  13.    [ ] YES  [ ] NO
  14.  
  15. COST 10 DOLLARS
  16. PLEASE MAKE CHECKS PAYABLE TO ANDREW TOSH
  17.  
  18. Comments or Suggestions
  19. _______________________________________________________________________________
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  35.                         Signature               Date
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  37.                         _____________________   __________
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