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  1. Divinity Order Form
  2.  
  3. Mail this completed form with payment to:                                     Fantasoft, LLC
  4.                                                                                                                                                                                                                                                                                                                                                                      P.O. Box 14261
  5. Call us at:  (608) 222-8468    to order by phone                               Madison, WI 53714-0261
  6. Fax this form to us at:  (608) 222-8468                                        USA
  7.  
  8. Last Name                                                                             First Name                                            
  9.  
  10. Address                                                                                                                         Apt#             
  11.  
  12.                                                                                                                                                            
  13.  
  14. City                                            State                 Zip/Post Code                     Country                       
  15.  
  16. Phone Number:                                       E-Mail Address:                                                                  
  17.  
  18.  
  19. I AM a registered owner of Realmz already.
  20. I would like to order:
  21. Divinity.........................................................Yes____$45
  22.  
  23. I am NOT a registered owner of Realmz already.
  24. I would like to order:
  25. Divinity (Includes Realmz & City of Bywater Scenario)............Yes____$65
  26.  
  27.  
  28. I would like to register additional scenarios for Realmz:
  29. "Assault On Giant Mountain" scenario.............................Yes____$13
  30. "Prelude To Pestilence" scenario.................................Yes____$13
  31. "Castle In The Clouds" scenario..................................Yes____$13
  32. "Destroy The Necronomicon" scenario..............................Yes____$13
  33. "White Dragon" scenario..........................................Yes____$13
  34. "Griloch's Revenge" scenario.....................................Yes____$13
  35. "Trouble in the Sword Lands" scenario............................Yes____$13
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  38. *Foreign orders add $3 for shipping and handling.     Total Due = $           
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