WINCOIN REGISTRATION FORM

Please print and return this form with your payment by check
for the amount indicated below to:

    Bob Stech
    5454 Kellogg Ct.
    Willoughby, Ohio 44094


Registration Fees
-----------------------------------------------------
[ ] WINCOIN v2.1                               $29.00
    Register me for Wincoin and send me
    my registration code and the latest
    version.


    Disk size _______ 5 1/4"  _______ 3 1/2"

-----------------------------------------------------
[ ] If I currently have the latest version,
    send my registration information now and
    send me the next version when it is available.
-----------------------------------------------------



Name ________________________________________________

Address _____________________________________________

City ___________________ State ________Zip___________


    Where did you get your copy of WINCOIN?

    ______________________________________


Suggestions or Comments:

_________________________________________________________

_________________________________________________________

Thank you for supporting the Shareware concept!