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  1. -----------------------------------------------
  2.                 Mail Order Form
  3. -----------------------------------------------
  4.  
  5. To order by mail, fill out this form by
  6. entering your answers between the brackets
  7. below.  Then print the form and mail it to:
  8.  
  9.               Joel Ryan Software
  10.                 P.O. Box 10364
  11.                Ogden, UT  84405
  12.  
  13.        --------------------------------
  14.              Program Name: ButtonWiz
  15.          Operating System: Win 95/98/NT
  16.        Registration Price: $14.95
  17.        --------------------------------
  18.  
  19. Make sure your e-mail address is correct! This
  20. is how you will receive your registration
  21. information.
  22.  
  23. Hotmail, Yahoo, USA.Net and other email
  24. forwarding addresses are NOT accepted.
  25.  
  26. -----------------------------------------------
  27.   Email Address: [ ]
  28.  
  29.       Full Name: [ ]
  30.  
  31.    Company Name: [ ]
  32.  
  33.  Street Address: [ ]
  34.  
  35.            City: [ ]
  36.  
  37.  State/Province: [ ]
  38.  
  39.         Country: [ ]
  40.  
  41.     Postal Code: [ ]
  42.  
  43.    Phone Number: [ ]
  44.  
  45.         CC Type: [ ] Visa
  46.      (Check One) [ ] MasterCard
  47.                  [ ] American Express
  48.                  [ ] Discover (Novus)
  49.  
  50.     Card Number: [ ]
  51.  
  52. Expiration Date: [ ]
  53.  
  54.          Copies: [ ]
  55.    ($14.95 Each)
  56.  
  57.    Where did you [ ]
  58.  hear about this
  59.         program?
  60.  
  61.  Other Comments: [ ]
  62.  
  63. -----------------------------------------------