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  1.                         ORDER FORM FOR ATOMS-3 V1.0
  2.  
  3.          Registered Prices:
  4.          ------------------
  5.  
  6.          ** Canadian Customers.....Cdn$30.50 (S/H & Tax incl) **
  7.  
  8.           ** Outside Canada.........US$25.00 (S/H included) **
  9.  
  10.          Benefits:
  11.          ---------
  12.          *  A one person practice mode with varying levels of difficulties!
  13.          *  Save game option!
  14.          *  No Shareware opening screen!
  15.          *  Slow motion replay!
  16.          *  Bonus game!
  17.          *  FREE technical support by phone, fax or mail!
  18.  
  19.          **************************************************************
  20.  
  21.          Yes I want to support the Shareware concept and register my
  22.          copy of Atoms-3 v1.0!
  23.  
  24.          Mr./Mrs./Ms.: ________________________________________________
  25.  
  26.          Address: _____________________________________________________
  27.  
  28.          City/Prov./State: _______________________ Country:____________
  29.  
  30.          Postal Code/Zip#: _____________________
  31.  
  32.          TELEPHONE:  ___________________________ (Optional)
  33.  
  34.          ===========================================================
  35.  
  36.          Quantity                                                Price
  37.          --------------------------------------------------------------
  38.  
  39.          _______  3-1/2" or 5-1/4" Atoms-3                    $________
  40.  
  41.                                                       TOTAL   $________
  42.  
  43.  
  44.          Visa # _ _ _ _ - _ _ _ - _ _ _ - _ _ _      Exp.Date:_________
  45.  
  46.          M/C# _ _ _ _ - _ _ _ _ - _ _ _ _ - _ _ _ _ Exp.Date:__________
  47.  
  48.          If paying by cheque/Money Order please make it payable to:
  49.                                 DISTANT MARKETS
  50.                      Box 1149, 194 - 3803 Calgary Trail S.
  51.                        Edmonton, Alberta CANADA T6J 5M8
  52.  
  53.              TOLL-FREE TELEPHONE: 1-800-661-7383 (Canada/USA)
  54.              TOLL-FREE FAX      : 1-800-661-9756 (Canada/USA)
  55.                    Elsewhere call     : 1-403-436-3009
  56.                    Elsewhere fax      : 1-403-435-0928
  57.  
  58.