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  1.      ______
  2.      ______ Secure-A-Term Version 1.00 <beta>
  3.      ______
  4.  
  5.             Send Check or money order payable in US funds to
  6.             "John Adams".
  7.  
  8.              John Adams
  9.              557 Columbus Ave
  10.              Apartment #502
  11.              Boston, MA 02118
  12.  
  13.      ---------------------------------------------------------------------
  14.  
  15.      Please Select format for this and future versions:
  16.  
  17.                [  ]   3.5" Low-Density (720kb)
  18.  
  19.                [  ]   3.5" High-Density (1.44mb)
  20.  
  21.                [  ]   5.25" Low-Density (360kb)
  22.  
  23.                [  ]   5.25" High-Density (1.2mb)
  24.  
  25.      ---------------------------------------------------------------------
  26.  
  27.                                Add $1 per copy for 3.5 disk  $________
  28.  
  29.            Shipping and handling outside US and Canada @ $4  $________
  30.  
  31.                                                     Total    $________
  32.  
  33.  
  34.                                   Signature ______________________________
  35.  
  36.  
  37.      Name       __________________________________________________________
  38.  
  39.      Address    __________________________________________________________
  40.  
  41.      City/State __________________________________________________________
  42.  
  43.      Country    _____________________  Phone   (______)___________________
  44.  
  45.      Where did you obtain SecuraTerm? ____________________________________
  46.  
  47.      Comments/Suggestions/Bug Complaints:_________________________________
  48.  
  49.      _____________________________________________________________________
  50.  
  51.      _____________________________________________________________________
  52.  
  53.  
  54.      You'll recieve your registered copy of Securaterm within 1-2 weeks
  55.      after completing and mailing this form. Thanks for supporting
  56.      Shareware!
  57.  
  58.      =====================================================================
  59.  
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