P R I M E   B A S E   D O O R   R E G I S T R A T I O N   F O R M

   TO:  William Rountree                           Date___/___/___
        7806 Lisa Dr.
        Apt # 203       
        Norfolk, Va.  23518

       (Please use capitalization and punctuation where necessary.)
 FROM:  SysOp Name: _______________________________________________
        BBS Name: _________________________________________________
        Address: __________________________________________________
        City: ______________________ State: __________ ZIP: _______
        Voice: (   ) _________________ BBS: (   ) _________________
        BBS Software: _____________________ BBS Hours: ____________
        Baud Rates:__________________ Front End Mailer: ___________

                       Current versions as of 10/1/93

  Doors             VERSION   PRICE      Doors               VERSION   PRICE      
  -----             -------   -----      -----               -------   -----
__Adventurer's Maze.. 2.34 ..$20.00    __Murder Mansion........2.31 ..$20.00

__Space Race..........1.30 ..$20.00    __BBS Putt Putt.........1.41 ..$15.00

  PCB Utilities     VERSION  PRICE       PCB Utilities       VERSION   PRICE 
  -------------     -------  -----       -------------       -------   -----
__Daily Report Gen....1.01 ..$10.00    __Caller's Log Trimmer..1.00 ..$ 5.00

 Subtotal (Column 1)         ______      Subtotal (Column 2)          ______

  ________ Subtotal (Column 1)

+ ________ Subtotal (Column 2)

- ________ Discounts: Order 2 or more programs within the same calander month.
           Order 2= $5.00, 3= $8.00, 4= $10.00

+ ________ $ 2.00: Call your BBS and leave you a message with the registation
             number.

+ ________ $ 5.00: Include with the registraion number, a copy of all my 
             current programs. 

= ________ Total Inclosed

Previously Registered: _____________________________________________________

==============================================================================
                           F E E D B A C K
                           ---------------
 I learned of this program from:

 [  ]-A Friend, [  ]-Computer Club, [  ]-Compuserve, [  ]-GEnie, [  ]-User           [  ] - Other
 [  ]-Another BBS (Name & #)_________________________________________________

 COMMENTS: __________________________________________________________________
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