SuperBase 1.1 - Registration Form
(C) Copyright 1992, by David Polmanteer

CHECK appropriate space:

$_____  Please rush my SuperBase registration code via U.S. mail.
        I have enclosed my registration fee of $10.00

$_____  Please send my SuperBase registration code via Netmail to
        my FidoNet Address listed below.  I have enclosed my registration
        fee of $10.00

Your name:  ________________________

Sysop name or BBS name as you want it to appear in the main menu
registration notice:

      "Registered To  ______________________________________"

Address:  _________________________________________________________________

City, St, Zip, Country:  __________________________________________________

                         __________________________________________________

Phone Number (voice) :   __________________________________________________

BBS name:  __________________________  BBS Phone number:  _________________

BBS software:  ______________________  Version:  __________________________

FidoNet Address: (for netmailed registration code) ________________________

Comments/Suggestions: _____________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

___________________________________________________________________________

Send payment to:                  Make Check/Money Order Payable to:
                                        David Polmanteer
David Polmanteer                        ~~~~~~~~~~~~~~~~
P.O. Box 190066
Burton, MI
      48519-0066              Note: Enclose this form with your payment.