REGISTRATION/ORDER FORM
                      TurboDraft Software Version 3.0
              "The" Phone/Fax/Internet Check Payment System
              =============================================

Complete the order form below (Call For Current Price!) and:

1) Email it to: sies@voicenet.com
2) Fax it to: 1-215-222-1853
3) Snail Mail: D Simmons Corporation
               Donald Thomas
               Suite 227
               4116 Chester Ave
               University City
               Philadelphia , Pa 19104

                   REGISTRATION INFORMATION
                   ========================

Today's Date: 
TurboDraft Serial#: 
  (Start TurboDraft, Select SETUP, Select REGISTRATION)
Your Name: 
Your Business Name:
Address: 
City: 
State: 
Postal Code: 
Email Address: 
Telephone Number: 

               =============================

ITEM/DESCRIPTION                                    AMOUNT
-------------------------------------------------  --------
1. Registration of TurboCheck Software               $
2. Optional 50 Checks by Priority Mail ($6.00)       $
3. Optional 100 Checks by Priority Mail ($10.00)     $
                                                   ========
            -----                        Subtotal   $   .
Thank you for your registration                    --------
  Your business is appreciated.             Total   $
            -----                                  ========
** If you did not choose #2/#3 add $3.00 postage 
               =============================

                  ==============================
                  = PAYMENT INFORMATION PART I =
                  ==============================

CHECK ORDERS:  (Please provide information as APPEARS ON CHECK)

Your Name: 
Your Address: 
Your City: 
Your State: 
Your Zip Code: 
Your Phone Number: 

Your Checking Account#:
Check#:
  [NOTE: Get out your check book and use the next available number]
  [Be sure to make an entry for this check in your Check Register]


Bank Name: 
Bank Address: 
Bank City: 
Bank State: 
Bank Zip Code: 
Bank Phone Number: 
Bank Routing#:
  [ This is the 9 digit# at the bottom of your check on the MICR Line ]

Branch Fraction:  TOP#:      BOTTOM#:
(NOTE: This is the Fraction at 
top-right of check near the check#)

CREDIT CARD ORDERS:
  Credit Card:  [ ]Visa   [ ]Master Card
  Account#:              (FIRST 8 DIGITS ONLY)
  Account# Remaining #'s:
  Expiration Date: