|----------------------------------------------------------------------------|| Street Shuffle Registration Form | |----------------------------------------------------------------------------|| Please complete all questions in this section: || || Name:_____________________________________________________________________ || | | Street Address:___________________________________________________________ || || City:________________________________ State:________ Zip:_________________ || | | What type of diskettes do you require? (Check one): || 3 1/2" DS/HD (1.4 mb) 1 disk ___ 3 1/2" DS/DD 2 disks (720 kb) ___ || 5 1/4" DS/HD (1.2 mb) 1 disk ___ 5 1/4" DS/DD 4 disks (360 kb) ___ || | | The registration fee for Street Shuffle is $7.00 US + $3.00 Shipping and || Handling. You need not include the Shipping and Handling fee if you || include the needed blank diskettes and a self-addressed, stamped envelope. || | | Check One: || I have enclosed payment of $10.00 ___ || I have enclosed payment of $7.00, all diskettes and an SASE ___ ||----------------------------------------------------------------------------|| Completion of the following information is optional: || | | What version of Windows (or OS/2) are you using?:______ || | | Where did you obtain this copy of Street Shuffle?: || Bulletin Board Service: Name:______________________ Phone #:______________ || Friend:___ || Other:____________________________________________________________________ || | | Any questions, comments, or future changes you would like to see made?: || __________________________________________________________________________ || __________________________________________________________________________ ||----------------------------------------------------------------------------|| Send your check or money order payable to Max Eissler and this form to: || | | Street Shuffle Registration || 4645 East Glen Ridge Circle || Winston, GA 30187 || | | Please allow 2 to 3 weeks for deliveries within the United States. ||----------------------------------------------------------------------------|