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  1.                     PROGRESSIVE PRODUCTS
  2.                         P.O. Box 1575
  3.                     Paso Robles, CA 93447
  4.  
  5.  
  6.                          ORDER FORM
  7.                          ==========
  8.  
  9.  
  10. Name________________________________________________________
  11.  
  12. Street Address______________________________________________
  13.  
  14. City _____________________________ State ____ ZIP __________
  15.  
  16. Country (Leave blank for USA) ______________________________
  17.  
  18. Have you registered with use before? [ ] Yes [ ] No
  19.  
  20. What software did this order form come with ________________
  21.  
  22. Where did you get the software from ________________________
  23.  
  24. Programs you are ordering/registering:
  25.  
  26. [ ]  Head Banger #1 Sliding Puzzle Game ................ $15
  27.  
  28. [ ]  PC-Nag ............................................ $25
  29.  
  30. [ ]  Both Head Banger #1 and PC-Nag .................... $30
  31.  
  32. Disk size:  [ ] 5 1/4" [ ] 3 1/2"
  33.  
  34. Amount enclosed: $________ (Calif. residents add sales tax.)
  35.  
  36. Payment by:  [ ] Check  [ ] Money Order
  37.              [ ] Visa   [ ] MasterCard
  38.  
  39. Card number: ___________________________________________
  40.  
  41. Expiration date: _____/_____ (MM/YY)
  42.  
  43.  
  44. Signature:   ___________________________________________
  45.  
  46. Please make check or money order payable to: Progressive Products
  47.  
  48. Mail to:  Progressive Products
  49.           P.O. Box 1575
  50.           Paso Robles, CA 93447
  51.