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  1. Chastity        R E G I S T R A T I O N        Pocket Change
  2.                             Software        
  3.                             Route 8, Box 644
  4.                             N. Wilkesboro, NC
  5.                             28659
  6.  
  7.  
  8. Your Name:        ___________________________________
  9. Your Address:        ___________________________________
  10.             ___________________________________
  11.             ___________________________________
  12.  
  13. Your Phone #:        ___________________________________
  14. (we ask for this information so that we can send you the documentation and
  15. other stuff as promised. If you don't want the stuff, check here [ ]).
  16.  
  17. The program name:    ___________________________________
  18. The program date:    ___________________________________
  19. The program size:    ___________________________________
  20. (we ask for this information to make sure no changes (viruses) are made to
  21. the program. In this unlikely event, you will be contacted immediately).
  22.  
  23. How you received this program:        ___________________________________
  24. From whom did you receive it:        ___________________________________
  25. How much you paid to receive it:    ___________________________________
  26. How much business you give them:    ___________________________________
  27. (we ask for this information so that we can evaluate our distributors).
  28.  
  29. Your honest opinion of the program:     ___________________________________
  30. ___________________________________________________________________________
  31. ___________________________________________________________________________
  32. Your honest opinion our Service      :     ___________________________________
  33. ___________________________________________________________________________
  34. ___________________________________________________________________________
  35. How can we make the program better:     ___________________________________
  36. ___________________________________________________________________________
  37. ___________________________________________________________________________
  38.  
  39. (we ask for this information because we really do care. Your opinion of us
  40. means everything. If there is ever anything we can do, please let us know).
  41.  
  42. Please mail this form, along with your registration fee to Pocket Change 
  43. Software at the address shown above.
  44.  
  45.