

                             QwkMan Order Form
                             =================
                                                            
          Name:________________________________________________
               First               Last

          Address:_____________________________________________
                  Number            Street            Apt.

          City:________________________ State:____  Zip:_______


          Phone:____________________      _____________________
                Voice                     Data

          Where did you obtain QwkMan?_________________________

          _____________________________________________________

          Comments:____________________________________________

          _____________________________________________________

          _____________________________________________________

          _____________________________________________________


                                                                Cost
                                                               ------
          ( ) Yes, I'd like to register QwkMan.                $15.00
            
          ( ) Please send me the latest version of QwkMan.      $5.00


                                            Total enclosed: _________


          Mail to:
          --------

              Keith Brown
              19431 Rue De Valore #54B
              Foothill Ranch, CA 92610 