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  1. ===============================[ ORDER FORM ]=================================
  2. LOMAX Software                           questions or comments :
  3. Kettelerstr.27                           +49 (0) 5973 / 5724
  4. 48485 Neuenkirchen                       Lomaxsoft@aol.com
  5. Germany                                  100625.1745@compuserve.com
  6.                                          http://www.lomaxgames.com/
  7. ==============================================================================
  8.  
  9.  
  10. 1.  Please mark the games you want to register and be sure to fill in all
  11.     required information.
  12.  
  13.   ---------------------------------------------------------------------------
  14.   | TITLE                                               | QNT | US$ | Total |
  15.   ---------------------------------------------------------------------------
  16.   | 3D-LomTris (Win95)                                  |     |14.95|       |
  17.   ---------------------------------------------------------------------------
  18.   | Lovely Girls (Win95)                                |     |14.95|       |
  19.   ---------------------------------------------------------------------------
  20.   | Cybersphere Plus                                    |     |17.95|       |
  21.   ---------------------------------------------------------------------------
  22.   | Diamco (Windows)                                    |     |14.95|       |
  23.   ---------------------------------------------------------------------------
  24.   | Terroid                                             |     |29.95|       |
  25.   ---------------------------------------------------------------------------
  26.   | Farocar (Windows)                                   |     |19.95|       |
  27.   ---------------------------------------------------------------------------
  28.   | Lomax ColTris                                       |     |24.95|       |
  29.   ---------------------------------------------------------------------------
  30.   | Lomax Boulders                                      |     |19.95|       |
  31.   ---------------------------------------------------------------------------
  32.   | Lomax Boulders II - Sea of Diamonds                 |     |19.95|       |
  33.   ---------------------------------------------------------------------------
  34.   | Lomax Boulders III - Mystic Walls                   |     |19.95|       |
  35.   ---------------------------------------------------------------------------
  36.   | StoneBreaker                                        |     |24.95|       |
  37.   ---------------------------------------------------------------------------
  38.   | Hidden Fields                                       |     |29.95|       |
  39.   ---------------------------------------------------------------------------
  40.   | Magics                                              |     |14.00|       |
  41.   ---------------------------------------------------------------------------
  42.   | 3D-LomTris        (SHAREWAREVERSION)                |     | 4.00|       |
  43.   ---------------------------------------------------------------------------
  44.   | Lovely Girls      (SHAREWAREVERSION)                |     | 4.00|       |
  45.   ---------------------------------------------------------------------------
  46.   | Cybersphere Plus  (SHAREWAREVERSION)                |     | 4.00|       |
  47.   ---------------------------------------------------------------------------
  48.   | DIAMCO            (SHAREWAREVERSION)                |     | 4.00|       |
  49.   ---------------------------------------------------------------------------
  50.   | Terroid           (SHAREWAREVERSION)                |     | 4.00|       |
  51.   ---------------------------------------------------------------------------
  52.   | FAROCAR           (SHAREWAREVERSION)                |     | 4.00|       |
  53.   ---------------------------------------------------------------------------
  54.   | Lomax ColTris     (SHAREWAREVERSION)                |     | 4.00|       |
  55.   ---------------------------------------------------------------------------
  56.   | Lomax Boulders    (SHAREWAREVERSION)                |     | 4.00|       |
  57.   ---------------------------------------------------------------------------
  58.   | Lomax Boulders II (SHAREWAREVERSION)                |     | 4.00|       |
  59.   ---------------------------------------------------------------------------
  60.   | Lomax Boulders III(SHAREWAREVERSION)                |     | 4.00|       |
  61.   ---------------------------------------------------------------------------
  62.   | StoneBreaker      (SHAREWAREVERSION)                |     | 4.00|       |
  63.   ---------------------------------------------------------------------------
  64.   | Hidden Fields     (SHAREWAREVERSION)                |     | 4.00|       |
  65.   ---------------------------------------------------------------------------
  66.   | Magics            (SHAREWAREVERSION)                |     | 4.00|       |
  67.   ---------------------------------------------------------------------------
  68.   | Shipping and Handling                               |  1  | 4.00|  4.00 |
  69.   ---------------------------------------------------------------------------
  70.   | If ordering from outside Europe add extra           |     | 2.00|       |
  71.   ---------------------------------------------------------------------------
  72.   | Foreign Bank Transaction Fee (if you send no US$) 1*|     | 2.00|       |
  73.   ---------------------------------------------------------------------------
  74.                                                         |   Total:  |       |
  75.                                                         ---------------------
  76.  
  77. 1* Only choose this if you send another currency than US dollars. You can
  78.    also send us the equivalent total of money in your country's currency,
  79.    but then you must choose this and pay 2.00 dollars extra.
  80.  
  81.  
  82.  
  83. 2. Please take the time to tell us how you got your shareware copy of 
  84.    3D-LomTris:
  85.  
  86. [ ] America Online 
  87. [ ] CompuServe (Name of forum): ____________________________________________
  88. [ ] Friend
  89. [ ] PsL
  90. [ ] Local BBS (Name & #): __________________________________________________
  91. [ ] Catalog (Name): ________________________________________________________
  92. [ ] CD (Name): _____________________________________________________________
  93. [ ] Other (Please specify): ________________________________________________
  94.  
  95. 3. Is this your first order with LOMAX Software:  
  96.   
  97. [ ] Yes                  [ ] No
  98.  
  99. 4. Please choose disk size:  
  100.  
  101. [ ]   5 1/4   1.2MB      [ ]   3 1/2   1.4MB
  102.  
  103. 5. Please choose payment type:      
  104.  
  105. [ ] Check                [ ] Money Order
  106.  
  107. 6. Please ship my order to:
  108.  
  109.        First Name: _________________________________________
  110.         
  111.         Last Name: _________________________________________
  112.         
  113.           Address: _________________________________________
  114.         
  115.              City: _________________________________________
  116.         
  117.   Zip/Postal Code: _________________________________________
  118.    
  119.             State: _________________________________________
  120.         
  121.           Country: _________________________________________
  122.         
  123.           Phone #: (___________)____________________________
  124.  
  125.  
  126.         Signature: _________________________________________
  127.  
  128. ALL ORDERS SHIPPED WITHIN 48 HOURS.
  129. THANKS FOR ORDERING.
  130.