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  1.       ActaeOn Version 1.60                         US Registration Form
  2.       -----------------------------------------------------------------
  3.         Send Card details to:
  4.           Jon Clempner
  5.           20, Norleigh Road
  6.           Northenden
  7.           Manchester
  8.           M22 4AZ            or CompuServe 100013,57
  9.           ENGLAND            or by phone to +44 61 998 8592
  10.       -----------------------------------------------------------------
  11.  
  12.       Quan       Item                             Price       Total
  13.  
  14.       ___  ActaeOn registration   ........... @ 34.95 dollars ________
  15.  
  16.       ___  3 1/2 inch disk supplement  ...... @  2.00 dollars ________
  17.  
  18.       ___  Shipping & Handling (Air Mail) ... @  5.00 dollars ________
  19.  
  20.  
  21.                                                       Total   ________
  22.  
  23.  
  24.          Visa/Master Card (Access) accepted. Checks or Money orders can
  25.          only be accepted if paid in UK Pounds sterling drawn on a UK
  26.          bank.
  27.  
  28.       -----------------------------------------------------------------
  29.        Check enclosed ____ Visa ____ Master Card ____ (tick as approp.)
  30.  
  31.         Name on Card ________________________________________________
  32.  
  33.         Card Number ________________________________ Expires ________
  34.  
  35.           Name_______________________________________________________
  36.  
  37.        Company_______________________________________________________
  38.  
  39.        Address_______________________________________________________
  40.  
  41.               _______________________________________________________
  42.  
  43.               _______________________________________________________
  44.  
  45.          Phone_________________________  Bus.________________________
  46.  
  47.       Where did you obtain ActaeOn?
  48.  
  49.               _______________________________________________________
  50.  
  51.  
  52.       ActaeOn Serial Number   _______________________________________
  53.  
  54.       Comments_______________________________________________________
  55.  
  56.               _______________________________________________________
  57.  
  58.               _______________________________________________________
  59.  
  60.               _______________________________________________________
  61.  
  62.       -----------------------------------------------------------------
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  64.  
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