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  1. |----------------------------------------------------------------------------|
  2. | Street Shuffle Registration Form                                           | 
  3. |----------------------------------------------------------------------------|
  4. | Please complete all questions in this section:                             |
  5. |                                                                            |
  6. | Name:_____________________________________________________________________ |
  7. |                                                                            | 
  8. | Street Address:___________________________________________________________ |
  9. |                                                                            |
  10. | City:________________________________ State:________ Zip:_________________ |
  11. |                                                                            | 
  12. | What type of diskettes do you require? (Check one):                        |
  13. | 3 1/2" DS/HD (1.4 mb) 1 disk ___         3 1/2" DS/DD 2 disks (720 kb) ___ |
  14. | 5 1/4" DS/HD (1.2 mb) 1 disk ___         5 1/4" DS/DD 4 disks (360 kb) ___ |
  15. |                                                                            | 
  16. | The registration fee for Street Shuffle is $7.00 US + $3.00 Shipping and   |
  17. | Handling.  You need not include the Shipping and Handling fee if you       |
  18. | include the needed blank diskettes and a self-addressed, stamped envelope. |
  19. |                                                                            | 
  20. | Check One:                                                                 |
  21. | I have enclosed payment of $10.00 ___                                      |
  22. | I have enclosed payment of $7.00, all diskettes and an SASE ___            |
  23. |----------------------------------------------------------------------------|
  24. | Completion of the following information is optional:                       |
  25. |                                                                            | 
  26. | What version of Windows (or OS/2) are you using?:______                    |
  27. |                                                                            | 
  28. | Where did you obtain this copy of Street Shuffle?:                         |
  29. | Bulletin Board Service: Name:______________________ Phone #:______________ |
  30. | Friend:___                                                                 |
  31. | Other:____________________________________________________________________ |
  32. |                                                                            | 
  33. | Any questions, comments, or future changes you would like to see made?:    |
  34. | __________________________________________________________________________ |
  35. | __________________________________________________________________________ |
  36. |----------------------------------------------------------------------------|
  37. | Send your check or money order payable to Max Eissler and this form to:    |
  38. |                                                                            | 
  39. |                                             Street Shuffle Registration    |
  40. |                                             4645 East Glen Ridge Circle    |
  41. |                                             Winston, GA           30187    |
  42. |                                                                            | 
  43. | Please allow 2 to 3 weeks for deliveries within the United States.         |
  44. |----------------------------------------------------------------------------|
  45.