REPLICA.COM

Fast Diskette Copier

Version 1.0

Registration Form

To:

Life Sciences Software

8925 271st Street, N.W., Suite 112

Box 1560

Stanwood, Washington 98292

I wish to become a registered user of Replica. Please send me the latest version and manual.

My name:

Address 1:

Address 2:

City, State, ZIP:

(To Washington State residents: Please add 7.9 percent for state sales tax in calculating the next item. As a licensed business in the State of Washington, we are required to collect the sales tax for purchases made within the state.)

I enclose $_____.00 for ____ copies of Replica (including Washington State sales tax, if applicable).

My diskette preference is (check one):

___ 5-1/4" ___ 3-1/2"

___________________________________________

(Signature)

Life Sciences Software thanks you for registering and supporting shareware.