
                       REGISTRATION FORM FOR 
                              COLS10
                   COPYRIGHT (C) 1995 CHUCK BERNT
                        ALL RIGHTS RESERVED


            DATE:



       YOUR NAME:

    COMPANY NAME:

         ADDRESS:

 CITY, STATE ZIP:

         COUNTRY:

   EMAIL ADDRESS:

-----------------------------------------------------------

 NUMBER OF LICENSES:    X $5.00   =
    (Simultaneous users)
                                 + ______
                   TOTAL ENCLOSED =

    Please make your check or money order (drawn on
    a U.S. bank in U.S. funds) payable to Chuck Bernt.

       SEND TO :   Chuck Bernt
                   22365 El Toro Rd., # 118
                   El Toro, Ca. 92630
                   U.S.A.



             --- THANK YOU FOR YOUR ORDER ---

