ORDER FORM FOR THE GUEST REGISTRY

	Send order form to:

        Jimmy Rose
        2000 Linden Ave.
        Middletown, OH
        45044-4435
	USA

        $12 to register The Guest Registry ($10 + $2 P/H)


        >>> Make Check or Money Order payable to: Jimmy Rose <<<


                            ORDER FORM

---------------------------- CUT HERE ----------------------------------

                       PLEASE PRINT CLEARLY


	Name:_____________________________________________________


	Company:__________________________________________________


	Street address:___________________________________________


	City:___________________________ ZIP code:________________


	Country:__________________________________________________


                 The following information is optional


        Phone:________________________ FAX:_______________________


	Age:_____________ Occupation:_____________________________




**      Following are network addresses for various networks,
**      If you have an address for a network please enter it:

        FidoNet:__________________________________________________


	InterNet:_________________________________________________


        CompuServe:_______________________________________________


	Other:____________________________________________________


**      If you operate a BBS, fill out the next fields:


	BBS name:________________________________________________


        BBS phone number(s):

	_________________________________________________________

**      Please tell us about your computer:

**      Machine type:

	[ ]     386SX           Processor speed:________MHz
	[ ]     386DX
        [ ]     486SX           Type of Printer:___________
	[ ]     486DX
        [ ]     Pentium
	[ ]     other:__________________________

	RAM:_______MB           Harddisk:________MB


**      Please tell us where you discovered The Guest Registry

        ________________________________________________________


        ________________________________________________________


        ________________________________________________________

**      Please insert your comments about The Guest Registry
      

	_________________________________________________________


	_________________________________________________________


	_________________________________________________________