--- Local Ordering of DR. FORM (tm) ---

    You can order DR. FORM v3.21 locally in the following countries.
Either fill out the form below and mail it to the respective address,
or call by phone for more information.

NOTE:  Fees are given in the "local currency" and include shipping/handling.

=============================================================================
THE NETHERLANDS:  CopyCats                 Phone/Fax:    +31 (0) 72-5745993
and BELGIUM       Postbus 1088             email: 100121.1562@compuserve.com
                  1700 BB Heerhugowaard    
                  NETHERLANDS

                  Registration Fee:  Dfl 95 (Dutch Florin)
                                     1805 BF (Belgian Franks)

- Include eurocheque or girobetaalkaart (made out in guilders or franks)
- Dfl: Transfer or deposit to postgiro 43.28.577 of CopyCats, Heerhugowaard
- BF: Transfer or deposit to postrek. 000-1656064-80 of CopyCats, Nederland
=============================================================================

                               Quantity       Price          TOTAL
                                           (From above)

     DR. FORM 3.21             ________  X  __________   =   __________

     (Call, write or fax for site license information)                 

     Unless otherwise requested, 3 1/2 inch disks will be shipped.


  Name _______________________________________________

  Company ____________________________________________

  Address ____________________________________________   Apt _____________

  City ____________________  State/Province _______________  Zip _________

  Country _________________   Phone ________________   Fax _______________