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  1.  
  2.  
  3.                 REGISTRATION FOR POWER PUTT MINIATURE GOLF
  4.  
  5.  
  6.      Name     ___________________________________
  7.  
  8.      Address  ___________________________________
  9.  
  10.               ___________________________________
  11.  
  12.               ___________________________________
  13.  
  14.      Phone    ___________________________________
  15.                                        
  16.      
  17.      Medium   5¼" _________     3.5" _________ 
  18.  
  19.      
  20.      Power Putt:   ________ copies  x  $15.00  =  $___________
  21.  
  22.      Shipping & Handling                              2 . 0 0
  23.  
  24.      PA Sales Tax (6% if applicable)               ___________
  25.  
  26.      Total Cost                                   $___________
  27.                                        
  28.                                                                             
  29.  
  30.      Send this to   John Buckwalter
  31.                     34 Troy Drive
  32.                     Lititz, PA  17543
  33.  
  34.  
  35.      Please allow two weeks for delivery.  Also, be sure to specify
  36.      the type of floppy disk (5¼" or 3.5").
  37.      
  38.