To                                                    Date  : __/__/19__
Andreas Klimke
Fuenf-Baeume-Weg 191
7900 Ulm
West GERMANY


SNAKE SNAP! REGISTRATION/ORDER
------------------------------

I'd like to order the latest full version of Snake Snap! (35 levels) with a
nice level editor.
                       Registration fee : 15 US-$

I'm paying like this :

   (  )  Enclosed is a a check or money order $ ____________.
  

   (  )  I pay by credit card : (please fill up)

   (  ) American Express    (  ) Visa    (  ) Diners Club    (  ) Master Card

   Account # _________________________  Expires _______  Bank # _____________

   Signature ________________________________________________________________
                           (all Credit Card orders must be signed.)


Please send to me Snake Snap! on a :

        (  ) 5.25 '' disc

        (  ) 3.5 '' disc


   My adress (please print) :

                   _________________________________ (Name)

                   _________________________________ (Adress)

                   _________________________________ (City)

           (State) ________  _______________________ (Zip)