Order form for ERS Internet ScreenSavers.  PLEASE TYPE OR PRINT NEATLY.

Name (yours) _____________________________________________

Address (likewise, yours) ________________________________

City/town ________________________________________________

Province/state _______________________Post/zip code ______

Country __________________________________________________

Daytime phone number _____________________________________

FAX number _______________________________________________

E-mail address ___________________________________________

How did you find this shareware?__________________________

Payment: [ ] Credit Card (see below)        [ ] Check
         [ ] Money Order    
                                                  
[ ] 3 1/2 inch disk    

[ ] No shipping: Check here if you wish to have us e-mail your registration 
number, user name, and password to you and not charge you shipping.  Or if you 
downloaded the software and don't want a copy on 3.5 disk. Note that if you 
choose this option, nothing will be sent to you by snail-mail or FAX.  

Shipping and handling                             $5.00
Screen Saver                                     $10.00                         			
TOTAL (US DOLLARS)                         _____________

Payment by MasterCard, or Visa card:
We can only accept MasterCard or Visa cards (no Discover cards, please.) 
We will need the following information:

Credit card number: ________________________________________
Expiry date:________________________________________________
The name as it appears on the card: ________________________
The billing address (if different from above)_______________
____________________________________________________________
The signature of its owner authorizing us
to debit it for the amount indicated above: ________________


Mail this form to:    ERS Internet ScreenSavers, 7913-A DeSiard St, Monroe, LA 71203. 
If you're paying by credit card, you can FAX it to (318) 345-0745.  E-mail to: 
sales@ersinternet.com.  
Phone: 1-888-474-0799. 

THANK YOU !!!