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  1. NOTE: THE REGISTER OPTION FROM THE PROGRAM WILL PRINT OUT THIS FORM WITH THE
  2.       INFORMATION ALREADY INSERTED INTO THE REGISTRATION FORM.
  3.  
  4.                           TakeHome REGISTRATION FORM
  5.                                ShareWare Source
  6.                                 S/N 91.01003.A
  7.  
  8.  
  9. TO:  R. G. Farnam
  10.      P. O. Box 333
  11.      Barker, TX  77413-0333
  12.  
  13.   Please register my copy of TakeHome under the ShareWare concept.  It is my
  14.   understanding that by registering, I will receive the most current version
  15.   of TakeHome and that I will be notified when upgrades become available.  I
  16.   will NOT distribute  the registered  version that I  receive which has the
  17.   ability to bypass ShareWare notices unless a site-license is obtained with
  18.   this registration.   If a site-license is obtained,  I will not distribute
  19.   more copies than the license allows.
  20.  
  21.                        Please Sign Here ______________________________________
  22.  
  23.  
  24. Registration For: _________________________________ /Name
  25.                   _________________________________ /Mailing Address
  26.                   _________________________________ /City, State, Zip
  27.  
  28. Telephone (Days): (___) ____-_________   (Used only if you need to be contacted
  29.       (Evenings): (___) ____-_________    concerning your registration.)
  30.  
  31.  ------------------------------------------------------------------------------
  32.  
  33. DESCRIPTION                           QUANTITY        PRICE          TOTAL
  34. ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~     ~~~~~~~~       ~~~~~~~        ~~~~~~~
  35. TakeHome Program (ver. 4.0)               1     x    $35.00   =    $ 35.00
  36. State/Local Customization(s) *           ___    x     10.00   =     ______
  37. Site Licenses                            ___    x     20.00   =     ______
  38. Optional Lotus 123 Worksheet **           1     x     10.00   =     ______
  39. Optional Shareware Version (Your S/N) **  1     x      5.00   =     ______
  40. 3-1/2 inch media  730K  ___ -{Please                  Shipping
  41. 5-1/4 inch media  360K  ___ -{Check                   & Handling      5.00
  42. 5-1/3 inch media  1.2MB ___ -{One                                 ---------
  43.                Total                                               $______
  44.  
  45. Payment made with:  ( )Personal Check   ( )Cashier's Check   ( )Money Order
  46.  
  47. -------------------------------------
  48. * Customization requested for the following states/localities:
  49.  
  50.  
  51. ----------------------------------------------------------------------------
  52. COMMENTS ON PROGRAM?
  53.  
  54. _____________________________________________________________________________
  55.  
  56. _____________________________________________________________________________
  57.  
  58. _____________________________________________________________________________
  59.  
  60. _____________________________________________________________________________
  61.  
  62. ** See UPDATE.40 and COMISION.DOC for further explanation of these options.
  63.