APPLICATION FOR RECEIVING COMMISSION CHECKS
     
     
     COMPANY NAME: ..................................................
     
     NAME: ................................. DATE OF BIRTH: .........
     
     ADDRESS: .......................................................
     
     CITY: ..........................................................
     
     STATE: .................................. ZIP: .................
     
     PHONE: ....................................
     
     (Formerly resale94.zip)   PRE-REGISTERED copy of INTROKIT.ZIP  $2.00
     
                       California orders PLEASE add your sales tax  .......
     
                                             SHIPPING POSTAGE PAID  ..n/a..
     
          Specify: (3.5 720K) disk or (5.25 360K) disk:       TOTAL .......
    
     
     Make check or money order out to: Kevin King (or) DISK-COUNT DATA
     
                          Kevin King, SysOp/Owner
                          Disk-Count Data
                          P.O. Box 277482
                          Sacramento, CA. 95827-7482
                          916-381-8746 VOICE
                          916-381-2851 24-HR BBS