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  1.                        ORDER FORM FOR CoffeeBreak Card Games!
  2.  
  3.          Registered Prices:
  4.          ------------------
  5.  
  6.          ** Canadian Customers.....Cdn$36.00 (S/H & Tax incl) **
  7.  
  8.           ** Outside Canada.........US$30.00 (S/H included) **
  9.  
  10.          **************************************************************
  11.          Yes I want to support the Shareware concept and register my
  12.          copy of CoffeeBreak Card Games so I may play all 6 games!
  13.  
  14.          Mr./Mrs./Ms.: ________________________________________________
  15.  
  16.          Address: _____________________________________________________
  17.  
  18.          City/Prov./State: _______________________ Country:____________
  19.  
  20.          Postal Code/Zip#: _____________________
  21.  
  22.          TELEPHONE:  ___________________________ (Optional)
  23.  
  24.          ===========================================================
  25.  
  26.          Quantity                                                Price
  27.          --------------------------------------------------------------
  28.  
  29.          _______  3-1/2" or 5-1/4" CoffeeBreak Card Games     $________
  30.  
  31.                                                       TOTAL   $________
  32.          --------------------------------------------------------------
  33.  
  34.          Visa # _ _ _ _ - _ _ _ - _ _ _ - _ _ _      Exp.Date:_________
  35.  
  36.          M/C# _ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _ Exp.Date:__________
  37.  
  38.          If paying by cheque/Money Order please make it payable to:
  39.                                 DISTANT MARKETS
  40.                      Box 1149, 194 - 3803 Calgary Trail S.
  41.                        Edmonton, Alberta CANADA T6J 5M8
  42.  
  43.              TOLL-FREE TELEPHONE: 1-800-661-7383 (Canada/USA)
  44.              TOLL-FREE FAX      : 1-800-661-9756 (Canada/USA)
  45.                    Elsewhere call     : 1-403-436-3009
  46.                    Elsewhere fax      : 1-403-435-0928
  47.  
  48.