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  1.  
  2.        ACCIDENTAL SOFTWARE
  3.        13245 SKIOMAH RD.
  4.        APPLE VALLEY, CA. 92307                       ASP CD-ROM  07/01/93
  5.         -----------------------------------------------------------------
  6.        |  NAME            : ___________________________                  |
  7.        |  ADDRESS         : ___________________________                  |
  8.        |    "             : ___________________________                  |
  9.        |    "             : ___________________________                  |
  10.        |  TODAYS DATE     : ___________________________                  |
  11.         -----------------------------------------------------------------
  12.                                   REGISTER
  13.         -----------------------------------------------------------------
  14.        |      ULTIMATE BLACKJACK PURCHASE & REGISTRATION REQUEST         |
  15.        |                                                                 |
  16.        |   SEND ME THE CURRENT VERSION OF ULTIMATE BLACKJACK ON DISK.    |
  17.        |                                                                 |
  18.        |   ULTIMATE BLACKJACK           $10.00 x (   )   $___________    |
  19.        |                                                                 |
  20.        |   SOUND BLASTER VOICE PACK     $ 5.00 x (   )   $___________    |
  21.        |                                                                 |
  22.        |   SHIPPING AND HANDLING               $ 3.00    $      3.00     |
  23.        |                                                                 |
  24.        |   Total the amounts and enclose        TOTAL    $___________    |
  25.        |   a check or money order as payment.                            |
  26.        |                                                                 |
  27.        |   FOREIGN ORDERS: Please use an international money order       |
  28.        |   and specify only U.S. currency.                               |
  29.        |                                         _____ 360k 5 1/4 DISK   |
  30.        |                                         _____ 1.20 5 1/4 DISK   |
  31.        |                                         _____ 720k 3 1/2 DISK   |
  32.        |                                         _____ 1.44 3 1/2 DISK   |
  33.         -----------------------------------------------------------------
  34.                                    SURVEY
  35.         -----------------------------------------------------------------
  36.        |                      SHAREWARE SURVEY                           |
  37.        |                                                                 |
  38.        |   How did this product come to your attention?                  |
  39.        |                                                                 |
  40.        |   ____ A. From a shareware vendor (name) _____________________  |
  41.        |   ____ B. From a BBS (name) __________________________________  |
  42.        |   ____ C. From a friend                                         |
  43.        |   ____ D. Other (please specify ______________________________  |
  44.        |                                                                 |
  45.        |   ------------------------------------------------------------  |
  46.         -----------------------------------------------------------------
  47.        THANKS
  48.  
  49.