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MEDIEVAL CHESS                                                        (c)1996
Order Form                                                     JV Enterprises
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I am sending you a payment of Fourteen Dollars ($14.00) for the
registration of Medieval Chess with my:

[ ]   Credit Card by Fax, Mail or E-Mail.
          Credit Card  [ M/C ]  [ Visa ]

          Account Number _________________________  Exp Date ____________

          Signature_______________________________ (for Fax or Mail)

[ ]   Enclosed Check or Money order by Mail only.

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                              
IMPORTANT:  The CODE that appears on the Order screen at the beginning of
the game in red is:
                      _________________


Please send my registration passcode by:


[ ]    E-Mail to: __________________ @ ________________________

[ ]    Fax.  # (________) ________ - _______________

[ ]    Mail.  My address is:

              _________________________________________

              _________________________________________

              _________________________________________


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       Mail         |      Fax        |      E-Mail        |     Phone
--------------------+-----------------+--------------------+-----------------
JV Enterprises      | (702) 433-3973  |jvent@vegas.infi.net| (702) 734-9689
PO Box 97455        |                 |                    |  10am - 6pm PT
Las Vegas, NV 89193 |                 |                    |    Mon - Fri
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