COMPUPIC PURCHASE ORDER / REGISTRATION FORM
I would like a copy of CompuPic!  I understand that I will receive my
own personalized password with which to register the CompuPic(CPIC)
software, and that by using CPIC agree to all terms of the CPIC
licensing agreement. I also understand that CPIC is protected by
Federal Copyright Laws and International Treaty Provisions, and will
not disclose my password to anyone.  If I operate a BBS, I understand
that the CPIC password is not in the public domain, and cannot be made
available for download for users of my or any other BBS.  I understand
that my correct phone number is required for registration and will be
kept strictly confidential.  Optional items marked with asterisk (*).

YOUR NAME:___________________________________ *Company:___________________
(PLEASE PRINT) First Name, Initial, Last name

Home Phone (_______) _______-________   *Work: (______) ______-___________

Addr:_____________________________________________________________________

City:_____________________________ State/Prov:_________ Zip:______________

How did you first discover CPIC?__________________________________________

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                                           -QTY-  --PRICE--    --TOTAL--

CompuPic Registration(s)                    ___   US $39.95  $____________
3.5 Disk (optional, not required)           ___   US $10.00  $____________
Sales Tax (8.25% - TX Residents Only)                        $____________
                                                ORDER TOTAL  $____________

Credit Card Number:    __VISA __MasterCard __AMEX __Discover __CHECK ENCL.

________/________/________/________ Exp:____/____  Sign:X_________________

SEND ME THE COMPUPIC REGISTRATION PASSWORD VIA:

___ E-Mail (CompuServe, AOL, or Internet)..TO:____________________________

___ FAX.......FAX NUMBER (incl area code) ________________________________

___ US Mail (to above address)

Send Orders to Photodex Corporation:
   Internet/WWW:     http://www.photodex.com  (e-mail: sales@photodex.com)
   CompuServe:       GO PHOTODEX              (e-mail: 74774,3570)
   America On-Line:  Keyword: Photodex        (e-mail: Photodex)

Voice: 1-800-37-PHOTO or 1-512-406-3020 (8:30-5:30 CST)
Fax:   1-800-377-4676 or 1-512-452-6825
Mail:  Photodex Corporation                   * Sales terms and pricing
       1106 Clayton Lane, #200W                 are subject to change
       Austin, Texas  78723                     without notice.