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  1.                      Poker Patience Ordering Form
  2.  
  3.                                       ┌─────────────────────────────────┐
  4.                                       │            Roman Cejka          │
  5.                                       │            V polich 3           │
  6.                                       │    568 02  SVITAVY              │
  7.                                       │            CZECH REPUBLIC       │
  8.                                       └─────────────────────────────────┘
  9.  
  10.  
  11.  Yes, I want my own copy of full version of Poker Patience:
  12. ----------------------------------------------------------------------------
  13.  
  14.      Name: ____________________________________________________________
  15.  
  16.   Address: ____________________________________________________________
  17.  
  18.      City: ____________________________________________________________
  19.  
  20.   Country: ____________________________________________________________
  21.  
  22.  
  23.  Please let me know, where did you get your shareware copy of Poker Patience:
  24. -------------------------------------------------------------------------------
  25.  
  26.       Check und complete:
  27.  
  28.       [ ] - BBS, Internet ... _________________________________________
  29.  
  30.       [ ] - Shareware Catalog _________________________________________
  31.  
  32.       [ ] - Other - please specify: ___________________________________
  33.  
  34.  
  35. Quantity  Description                                              Cost
  36.  
  37. ________  Latest full version of Poker Patience ($15 per copy)    _______
  38.  
  39.           Shipping and handling (Europeans $3, others $5 for
  40.           the first item; all $1 for each other item              _______
  41.  
  42.                                                        Total:     _______
  43.  
  44. Note:
  45. Send the check rather than money. Please send the order and the check as
  46. a letter of recommendation reference.
  47.  
  48.  
  49. Reminders, remarks, comments and criticisms are welcomed:
  50. ----------------------------------------------------------------------------