
			SIMPLY ADDRESS...

			REGISTRATION  FORM



NAME:  ______________________________________
            (please print) 

ADDRESS: ____________________________________


CITY: _______________________________________


STATE: ____  ZIP __________ 


DISK SIZE:  [] 3 1/2  [] 5 1/4   [] HIGH DENSITY  [] LOW DENSITY


COMMENTS \ SUGGESTIONS: ________________________________

________________________________________________________

________________________________________________________



       QTY
  
1 to 2 copies   __ x $7.95 = ___
3 to 5 copies   __ x $6.95 = ___
6 or more       __ x $5.95 = ___

Shiping and handling:       $2.00       

Total for Order:            _____

*Please allow seven working days for delivery.


Make check or money order payable to:

Mark Grant
1243 South Citrus Ave.
Los Angeles, CA 90019



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