Your name:
_____________________________________
Name on card:
__________________________________
Address:
______________________________________
City:
________________________
State: _____________
Zip code: ______________ Phone:
__________________
Email address (if any):
____________________________
Phone number:
__________________________________
Optional CD-ROM (add extra
$6.00): __________________
Credit card: __
Visa __ Master Card
__ American Expr.
Name of bank that issued the
card: ___________________
Credit card number:
______________________________
Expires: ________ Signature:
______________________
* Please print very, VERY
clearly! *
Mail this order form to:
PC
Shareware, Inc. P.O. Box 661 Fredericksburg, VA 22404 USA