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  1.                         BlackJack! Registration Form
  2.  
  3.    Telephone Orders (314) 458-2863 (Evenings - Central Time)
  4.    Compuserve 72416,1362   Prodigy CBKG57A  Internet CBKG57A@Prodigy.com
  5.  
  6.    MAIL TO:  DONALD L. GRANGER
  7.              GLENCOE COMPUTING
  8.              2025 Wakefield Lake
  9.              Glencoe, Missouri
  10.                  63038-1210
  11.  
  12.  
  13.    NAME:   ______________________________________     DATE: ___/___/___
  14.  
  15.    ADDRESS:______________________________________
  16.  
  17.    CITY:   ______________________________________
  18.  
  19.    STATE:  ______________  ZIP: _________-_______  COUNTRY: _____________
  20.  
  21.    PHONE:  (____)____-________(in case there's a question about your order)
  22.  
  23.    ___ Registration with documentation on diskette $29.99
  24.           (HP, Epson, & Plain formatting)
  25.    ___ Registration with professionally printed documentation $37.50
  26.    ___ Registration with commented source code & printed documentation $99.99
  27.        (BlackJack! is written in C and Assembler).
  28.    _X_ Poker! (Slot Poker simulation) FREE with registration
  29.                                       ~~~~
  30.    International (except Canada) orders please add $3.50 for AIR shipping.
  31.       Be sure to make payment in US funds ($) payable through a US bank.
  32.  
  33.    Where did you obtain your copy of BlackJack! ?: _______________________
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  35.    YOUR HARDWARE:
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  37.    Computer _______________  Video adapter ______________ Fixed disk? ____
  38.  
  39.    Diskette size desired:     5 1/4" floppy:_____     3 1/2" micro:_____
  40.    +----------------------------------------------------------------------+
  41.    |                   MASTERCARD AND VISA ARE WELCOME!                   |
  42.    |                                                                      |
  43.    |   Act #_______________________________________   Ex Date ____/____   |
  44.    |                                                                      |
  45.    |   Signature required for credit cards ____________________________   |
  46.    +----------------------------------------------------------------------+
  47.  
  48.    AMOUNT ENCLOSED: $____________
  49.  
  50.    COMMENTS:
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  61.    Your support is greatly appreciated.                         250d9408
  62.    ------------------------------------+----------------------------------
  63.                      Please allow 1-2 weeks delivery time                 
  64.