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  1.                                 ORDER FORM
  2.                       VBSYX 2.2 and XG/GS MIDI Jukebox
  3.                           FOR UNITED STATES ORDERS
  4.                           ========================
  5.  
  6.  
  7.     Name:                             _________________________________
  8.  
  9.     Company/Address:                  _________________________________
  10.  
  11.                                       _________________________________
  12.  
  13.                                       _________________________________
  14.  
  15.     Your Telephone Number:            _________________________________
  16.                                          (include area/country code)
  17.  
  18.  
  19.     Your E-Mail Address:    ___________________________________________
  20.                                   (Must be reachable via Internet)
  21.  
  22.                              Registration Name
  23.       (Capitalization and Punctuation will be used exactly as listed)
  24.       ---------------------------------------------------------------
  25.  
  26.  
  27.     Your Name (required):             _________________________________
  28.  
  29.  
  30.     Price Calculation
  31.     -----------------
  32.  
  33.     Registration Fee: $24.95 per copy
  34.  
  35.  
  36.     Registration Fee: _____ copies @ $24.95 each = ___________
  37.  
  38.     Texas residents add Sales Tax:                 ___________
  39.     (8.25% Dallas MTA, 7.25% other)
  40.  
  41.     Total Cost:                                    ___________
  42.  
  43.  
  44.     Checks or Money orders:  Make payable in U.S. currency on a U.S. bank.
  45.                              DO NOT SEND CASH!!!!!
  46.  
  47.     Send this entire form with your check or money order (again, no cash)
  48.     payable to Lee Jackson to the following address:
  49.  
  50.                           Lee Jackson
  51.                           3960 Broadway Suite 235
  52.                           Garland TX 75043
  53.  
  54.     Please allow 6-8 weeks for delivery of mailed registration keys, and
  55.     5-10 days for delivery of keys via e-mail.
  56.  
  57.  
  58.     How did you receive your copy of VBSYX and/or XG/GS MIDI Jukebox?
  59.  
  60.     [ ] CompuServe
  61.  
  62.     [ ] America Online
  63.  
  64.     [ ] Prodigy
  65.  
  66.     [ ] FidoNet (please list node)  ______________________________________
  67.  
  68.     [ ] World Wide Web site or FTP site  _________________________________
  69.  
  70.     [ ] Other BBS  _______________________________________________________
  71.  
  72.     [ ] Catalog __________________________________________________________
  73.  
  74.     [ ] Other ____________________________________________________________
  75.  
  76.  
  77.  
  78.     Do you have any comments or suggestions?
  79.  
  80.  
  81.     ______________________________________________________________________
  82.  
  83.     ______________________________________________________________________
  84.  
  85.     ______________________________________________________________________
  86.  
  87.     ______________________________________________________________________
  88.  
  89.     ______________________________________________________________________
  90.  
  91.     ______________________________________________________________________
  92.  
  93.     ______________________________________________________________________
  94.  
  95.  
  96.     Thank you for ordering VBSYX and XG/GS MIDI Jukebox!
  97.  
  98.  
  99.