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  1. ===============================[ ORDER FORM ]=================================
  2. LOMAX Software                             questions or comments :
  3. Kettelerstr.27                             (+49) 05973 / 5724
  4. 48485 Neuenkirchen                         http://www.lomaxsoft.simplenet.com
  5. Germany                                    Lomaxsoft@aol.com
  6.                                            100625.1745@compuserve.com
  7. ==============================================================================
  8.  
  9.  
  10. 1.  Please mark the games you want to register and be sure to fill in all
  11.     required information.
  12.  
  13.   ---------------------------------------------------------------------------
  14.   | TITLE                                               | QNT | US$ | Total |
  15.   ---------------------------------------------------------------------------
  16.   | Lomax Boulders                                      |     |29.95|       |
  17.   ---------------------------------------------------------------------------
  18.   | StoneBreaker                                        |     |24.95|       |
  19.   ---------------------------------------------------------------------------
  20.   | Hidden Fields                                       |     |29.95|       |
  21.   ---------------------------------------------------------------------------
  22.   | Magics                                              |     |14.00|       |
  23.   ---------------------------------------------------------------------------
  24.   | Mega Collection: StoneBreaker,                      |     |49.95|       |
  25.   | Hidden Fields and Magics                            |     |     |       |
  26.   ---------------------------------------------------------------------------
  27.   | Lomax Boulders   (SHAREWAREVERSION)                 |     | 4.00|
  28.   ---------------------------------------------------------------------------
  29.   | StoneBreaker     (SHAREWAREVERSION)                 |     | 4.00|       |
  30.   ---------------------------------------------------------------------------
  31.   | Hidden Fields    (SHAREWAREVERSION)                 |     | 4.00|       |
  32.   ---------------------------------------------------------------------------
  33.   | Magics           (SHAREWAREVERSION)                 |     | 4.00|       |
  34.   ---------------------------------------------------------------------------
  35.   | Shipping and Handling                               |  1  | 4.00|  4.00 |
  36.   ---------------------------------------------------------------------------
  37.   | If ordering from outside Europe add extra           |     | 2.00|       |
  38.   ---------------------------------------------------------------------------
  39.   | Foreign Bank Transaction Fee (if you send no US$) 1*|     | 2.00|       |
  40.   ---------------------------------------------------------------------------
  41.                                                         |   Total:  |       |
  42.                                                         ---------------------
  43.  
  44. 1* Only choose this if you send another currency than US dollars. You can
  45.    also send us the equivalent total of money in your country's currency,
  46.    but then you must choose this and pay 2.00 dollars extra.
  47.  
  48.  
  49.  
  50. 2. Please take the time to tell us how you got your shareware copy of 
  51.    Lomax Boulders:
  52.  
  53. [ ] America Online 
  54. [ ] CompuServe (Name of forum): ____________________________________________
  55. [ ] Friend
  56. [ ] Local BBS (Name & #): __________________________________________________
  57. [ ] Catalog (Name): ________________________________________________________
  58. [ ] CD (Name): _____________________________________________________________
  59. [ ] Other (Please specify): ________________________________________________
  60.  
  61. 3. Is this your first order with LOMAX Software:  
  62.   
  63. [ ] Yes                  [ ] No
  64.  
  65. 4. Please choose disk size:  
  66.  
  67. [ ]   5 1/4   1.2MB      [ ]   3 1/2   1.4MB
  68.  
  69. 5. Please choose payment type:      
  70.  
  71. [ ] Check                [ ] Money Order
  72.  
  73. 6. Please ship my order to:
  74.  
  75.        First Name: _________________________________________
  76.         
  77.         Last Name: _________________________________________
  78.         
  79.           Address: _________________________________________
  80.         
  81.              City: _________________________________________
  82.         
  83.   Zip/Postal Code: _________________________________________
  84.    
  85.             State: _________________________________________
  86.         
  87.           Country: _________________________________________
  88.         
  89.           Phone #: (___________)____________________________
  90.  
  91.  
  92.         Signature: _________________________________________
  93.  
  94. IF YOU CHOOSE THE PAYMENT TYPE "MONEY ORDER", PLEASE ONLY SEND NOTES.
  95. MAKE CHECKS PAYABLE TO "LOMAX SOFTWARE".
  96. ALL ORDERS SHIPPED WITHIN 48 HOURS.
  97. THANKS FOR ORDERING.
  98.