REGISTRATION FOR DOSCAN V2.03

        Please print out this form, sign it and mail it along with your
        registration payment.

        Please make payment to:     Larry Edwards
                                    P.O. Box 3429
                                    Kent, Washington 98032

        Please register one copy of "DOSCAN" for each user at your site.

         DOSCAN Registration  Qty. _____ @ $15.00 ea.           = ___________

         Wash. Residents Add Applicable Sales Tax               + ___________

         Handling and shipping charge for mailing disk $5.00    + ------$5.00

         Total Payment                                           $-----------

       PAYMENT MUST BE IN US DOLLARS OR YOUR ORDER CAN NOT BE PROCESSED
             *** MAKE ALL CHECKS PAYABLE TO: LARRY EDWARDS ***

         Please denote the size disk you wish to receive your copy on.


        Name:  ___________________________________________________

        Address:  _________________________________________________

 City, State, Zip:  _______________________________________________

        COUNTRY:  _________________________________________________

        Voice Phone: Day ____________________  Eve:  ______________

        Signature:  ______________________Date:____________________

        Where did you get your copy of DOSCAN? ____________________
        ___________________________________________________________

        How do you want the REGISTERED TO line to read?
        ___________________________________________________________

        Disk size wanted? ________________