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  1.                                  DIZIT v1.1
  2.                               Registration Form
  3.                 Please support shareware by registering it.
  4.                 
  5.                         Remit To:     Robert Neal        
  6.                                       317 Hickory
  7.                                       Romeoville, IL  60441   
  8. --------------------------------------------------------------------------
  9.                            ** REGISTRATION **
  10.  
  11. Registration Options (select one):
  12.  
  13. [ ] - Registration key information via support BBS       $10.00      _____
  14.        Please be sure you have an account prior
  15.        so that I may leave you a private message
  16.        addressed to you with registration information.
  17.  
  18.  
  19. [ ] - Registration key letter via the U.S. Mail          $10.00      _____
  20.  
  21.  
  22. [ ] - Registration key letter plus current version       $15.00      _____
  23.        on disk. Disk choice: [ ]-5.25"  [ ]-3.25"
  24.  
  25.  
  26.                                                    Total ->         ______
  27.  
  28.  
  29.     ** Payment by Check (U.S. Bank or branch) or Money Order only **
  30.                         Thank you for your support.             
  31. --------------------------------------------------------------------------
  32.  
  33.    Name: _________________________________
  34.    
  35. Address: _________________________________
  36.  
  37.          _________________________________
  38.          
  39. BBS Name to enter in registration (30 char max)          Phone number
  40.  
  41.  _______________________________________            (    ) _____ - ________  
  42.  
  43.                                                     Baud Supported: _______
  44.  
  45. ---------------------------------------------------------------------------
  46.  
  47. Fold at the page break below with the printing facing out.  Then fold
  48. letter style, exposing the mailing address and hiding your information.
  49. If necessary, staple check to the mailer, then staple or tape sides and top.
  50.  
  51. _________________________________                                     Place
  52.  
  53. _________________________________                                     Stamp
  54.  
  55. _________________________________                                     Here
  56.  
  57.  
  58.  
  59.  
  60.  
  61.                                          Robert Neal         
  62.                                          317 Hickory         
  63.                                          Romeoville, IL  60441    U.S.A.
  64.  
  65.  
  66. DIZITv1.1
  67.