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  1. ===============================[ ORDER FORM ]=================================
  2. Lomax Software Productions                             questions or comments :
  3. Kettelerstr.27                                         Germany / 02553 / 80763
  4. 48485 Neuenkirchen
  5. Germany
  6. ==============================================================================
  7.  
  8.  
  9. 1.  Please mark the games you want to register and be sure to fill in all
  10.     required information.
  11.  
  12.   ---------------------------------------------------------------------------
  13.   | TITLE                                               | QNT | US$ | Total |
  14.   ---------------------------------------------------------------------------
  15.   | StoneBreaker                                        |     |19.95|       |
  16.   ---------------------------------------------------------------------------
  17.   | Hidden Fields                                       |     |29.95|       |
  18.   ---------------------------------------------------------------------------
  19.   | Magics                                              |     |14.00|       |
  20.   ---------------------------------------------------------------------------
  21.   | Mega Collection: StoneBreaker,                      |     |49.95|       |
  22.   | Hidden Fields and Magics                            |     |     |       |
  23.   ---------------------------------------------------------------------------
  24.   | StoneBreaker  (SHAREWAREVERSION)                    |     | 4.00|       |
  25.   ---------------------------------------------------------------------------
  26.   | Hidden Fields (SHAREWAREVERSION)                    |     | 4.00|       |
  27.   ---------------------------------------------------------------------------
  28.   | Magics        (SHAREWAREVERSION)                    |     | 4.00|       |
  29.   ---------------------------------------------------------------------------
  30.   | Shipping and Handling                               |  1  | 4.00|  4.00 |
  31.   ---------------------------------------------------------------------------
  32.   | If ordering from outside Europe add extra           |     | 2.00|       |
  33.   ---------------------------------------------------------------------------
  34.   | Foreign Bank Transaction Fee (if you send no US$) 1*|     | 2.00|       |
  35.   ---------------------------------------------------------------------------
  36.                                                         |   Total:  |       |
  37.                                                         ---------------------
  38.  
  39. 1* Only choose this if you send another currency than US dollars. You can
  40.    also send us the equivalent total of money in your country's currency,
  41.    but then you must choose this and pay 2.00 dollars extra.
  42.  
  43.  
  44.  
  45. 2. Please take the time to tell us how you got your shareware copy of Magics:
  46.  
  47. [ ] America Online     [ ] CompuServe            [ ] Prodigy
  48. [ ] ZiffNet            [ ] Software Creations    [ ] Friend
  49. [ ] Local BBS (Name & #): __________________________________________________
  50. [ ] Catalog (Name): ________________________________________________________
  51. [ ] CD (Name): _____________________________________________________________
  52. [ ] Other (Please specify): ________________________________________________
  53.  
  54. 3. Is this your first order with Lomax Software:  
  55.   
  56. [ ] Yes                  [ ] No
  57.  
  58. 4. Please choose disk size:  
  59.  
  60. [ ]   5 1/4   1.2MB      [ ]   3 1/2   1.4MB
  61.  
  62. 5. Please choose payment type:      
  63.  
  64. [ ] Check                [ ] Money Order
  65.  
  66. 6. Please ship my order to:
  67.  
  68.        First Name: _________________________________________
  69.         
  70.         Last Name: _________________________________________
  71.         
  72.           Address: _________________________________________
  73.         
  74.              City: _________________________________________
  75.         
  76.   Zip/Postal Code: _________________________________________
  77.    
  78.             State: _________________________________________
  79.         
  80.           Country: _________________________________________
  81.         
  82.           Phone #: (___________)____________________________
  83.  
  84.  
  85.         Signature: _________________________________________
  86.  
  87. IF YOU CHOOSE THE PAYMENT TYPE "MONEY ORDER", PLEASE ONLY SEND NOTES.
  88. MAKE CHECKS PAYABLE TO "LOMAX SOFTWARE".
  89. ALL ORDERS SHIPPED WITHIN 24 HOURS.
  90. THANKS FOR ORDERING.
  91. ****************************************************************************** 
  92.        ATTENTION:  DO NOT WRITE IN THIS SECTION (FOR OFFICE USE ONLY)
  93.  
  94. Date received: ____/____/____                    Date shipped : ____/____/____
  95. ******************************************************************************
  96.  
  97.