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Text File  |  1994-01-06  |  857b  |  30 lines
  1.                 First Name:
  2.                  Last Name:
  3.              Date of Birth:
  4.             Street Address:
  5.                Apt. Number:
  6.                       City:
  7.                      State:
  8.                   Zip Code:
  9.               Zip Code Ext:
  10.                 Home Phone:
  11.                 Work Phone:
  12.  
  13.                    Library:
  14.  
  15.                    Product  Price Total
  16.                    -------- ----- -----
  17.                    WAPSWGT    $10
  18.                    WAPSVAL    $10
  19.                    WAPSCALC   $10
  20.                                   -----
  21.                    Grand Total:
  22.  
  23.                    Make checks payable to Userware.
  24.   
  25.                    Send to:
  26.   
  27.                             UserWare / Shazam Software
  28.                             4 Falcon Lane East
  29.                             Fairport, NY 14450
  30.