Send to:

PD Profi Zoettlein GmbH		Phone: +49-8432-1296
Schulstr. 13			Fax:   +49-8432-8674
86666 Burgheim			CIS:   100326,53
Germany



Name:_______________________________________________________________

Address:____________________________________________________________

City:___________________________________ State:______ ZIP:__________

Country:____________________________________________________________

Phone:_____________________________ Fax:____________________________

EMail:_____________________________


YES! I would like to purchase my personal registration number
for Dave Dude 95, Release 2:

Registration# for Dave Dude 95, Release 2................._________
    (before March 31st 1995 DM 29,- after that DM 39,-)

Shipping and handling (worldwide).........................  DM 10,-
    
						    Total:_________
I pay by  [ ] eurocheque(included)  or

[ ] VISA  or  [ ] MasterCard  or  [ ] AmEx

Card#(16 digits):__ __ __ __  __ __ __ __  __ __ __ __  __ __ __ __ 

Expiration Date: __ __ / __ __ Cardholders name: __________________

Cardholders Signature: ____________________________________________



Date:__________________________ Signature:_________________________