SIMPLE LOCK ORDER FORM



QUANTITY           ITEM                                             PRICE

_________________________________________________________________________

_______              Simple LOCK for Windows 95                    $10.00

_______              Simple LOCK for Win 3.1/Workgroups            $10.00

_______              Simple LOCK for Macinotosh                    $10.00          


Your Name           
______________________________________________

Your Address      
______________________________________________

Your City              
______________________________________________

Your State
______________________________________________

Your Zip Code
______________________________________________

Your Telephone # 
______________________________________________

Your E-Mail Address (Example: DBSoftware@aol.com)
______________________________________________



AMOUNT ENCLOSED   $______.00             ____ Check           ____M.O.

DISKETTE SIZE:              ____ 3.5             ____ 5.25

SENDING OPTION:     _____ E-Mail      ______ Diskette
 

(Make Check or Money Order payable to Anthony Cocciolo)


Mail this page and your Check or Money Order to:

                                   ANTHONY COCCIOLO
                                   13886 PHEASANT KNOLL LANE
                                   MORENO VALLEY, CA 92553