Crazy Larry's Automated Subscription Service Order Form
         =-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=
         Please complete this form to the best of your knowledge

         Your Full Name: _______________________________________

         Your BBS Name : _______________________________________
         
         Sysops Name as Entered in wcConfig: ___________________

         Your BBS Registration number in wcConfig: ____-________

         Address : _____________________________________________

         City: ___________________________ State: ______________

         Country: __________________________ Zip: ______________

         Home Phone: _________________ BBS Phone: ______________

         =-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=

         How long would     [ ]  One Month ..............  $5.00
         you like to        [ ]  Three Months ........... $15.00    
         have your wcCode   [ ]  Six Months ............. $30.00
         applications       [ ]  One Year ............... $50.00
         registered?        [ ]  Lifetime Subscription .. $75.00

         =-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=
          How would you like to receive your subscription key?

         [ ] Via Crazy Larry's Online Art BBS
             Please provide your user name _____________________

         [ ] Via MIME-Encoded Internet E-Mail (fastest)
             E-Mail Address ____________________________________
         =-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=-=
             How would you like to pay for this subscription?

         [ ] Check          [ ] Visa        [ ] Master Card
         [ ] Money Order    [ ] Discover    [ ] American Express
             
         Card Number: _____ _____ _____ _____   Expires: ___/___

         Name on Credit Card: __________________________________

         All Credit Card orders will be proccessed by "Twi Tech"
         systems.  Your Credit Card statement will a charge from
         this Business.

         If paying by check or M.O. Please make it payable to
         "Larry Massengale Jr."

         By using any C.L.O.A. product, you assume all liability
         for it.   The author cannot be held responsible for any
         damages that may  result from the use, or misuse of any 
         program.  Furthermore, the author reserves the right to
         stop the production of wcCode applications at any given
         time without any prior notice.  

             Send this completed form to:

                 BITWISE COMPUTERS
                 P.O. Box 829 
                 Forest Grove, OR
                 97116-0829