.-------------JMedia v1.0------------.      BLUEVIEW SOFTWARE
| Origin: BLUEVIEW SOFTWARE          |      2300 Lawrence Ave. East BOX 80551
|       : SIMTEL                     |      Scarborough, Ontario
|       :                            |      CANADA  M1P 2R0
`------------------------------------'      (416) 757-7944

Name:
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Address:
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City/Town:                        State/Province:
          ________________________               ___________________________

Zip/Postal Code:                         Country:
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Phone Number   : (     )                    Date:
                ________________________         ___________________________

Email Address  :
                ____________________________________________________________
                (Compuserve ID / Internet / Fido-Netmail / RIME)

Name of BBS or Vendor where JMedia was obtained from:
(If bbs, please include the phone number of the BBS)

____________________________________________________________________________

Computer       :  [ ] XT    [ ] 286      [ ] 386    [ ] 486  [ ] Other
Display Card   :  [ ] VGA   [ ] SVGA     [ ] Other
CD-ROM         :  [ ] YES   [ ] NO
OS             :  [ ] DOS   [ ] WINDOWS  [ ] OS/2
Disk Type      :  [ ] 5 1/4 [ ] 3 1/2


Comments/Suggestions:

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U.S. residents send $20.00 + $3.00 S&H in U.S. funds.
Ontario residents send $24.00 + $3.00 S&H + 8% PST in Canadian funds.
Canadian residents send $24.00 + $3.00 S&H in Canadian funds.
International orders send $24.00 + $4.00 S&H in Canadian funds.


Amount enclosed:
                ____________________________________________________________

Make check or money order payable to BLUEVIEW SOFTWARE.