Registration form for Cocktail Database v1.01

Name: ______________________________________________________________________

Postal Address:_____________________________________________________________

Phone:(work)________________ (a/h)________________

Where did you aquire this software:

____________________________________________________________________________

Any comments, suggestions or bug reports:

____________________________________________________________________________

____________________________________________________________________________

All payments to be in Australian dollars only please.

I wish to purchase ____ copies of Cocktail Database at $25 each     $______

Postage and handling is $0 in Australia and $5 elsewhere           $______

Enclosed is a cheque/money order to the value of                    $______

Please make cheques payable to Sam Gillham. Allow 28 days for delivery.