wcSECURE Registration                                      V1.15 (12/94)

Print out and complete this form. Payment by check, money order
or credit card accepted. (Personal check orders are delayed 5-7 days
after receiving your order to allow checks to clear. Money Orders &
Credit Card Transactions processed immediately upon receipt)

Payable to / Mail to:   Capital City On-Line
                        800 Sleater Kinney SE #176
                        Lacey, WA 98503  (USA)                        
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The following information is used in the creation of your individual
KEY file, and **MUST** match your MAKEWILD configuration, EXACTLY, 
or the KEY will not work:

BBS NAME: ________________________________________________

SYSOP NAME: ______________________________________________

WILDCAT REGISTRATION NUMBER: _____________________________

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Your Name: _______________________________________________

Address: _________________________________________________

City: ____________________________________________________

State: _____  Zip Code: ___________  Birthdate: ____ / ____ / ____

Please Select a Password: ________________

Voice Phone: ______________________________

BBS Phone: ________________________________

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 Download Key from Support BBS  (206-956-1123)                   $30.00 **
 (An account will be created for you, and a message           (US Dollars)
  with the KEY attached will be sent to you upon        
  payment verification)                               ** Special: $19.00!   

** Orders Processed Prior to 01/01/95 receive a $11.00 discount and free
   registration KEY file for wcSPY V1.01. ($35.00 Value!) ==========================================================================
Select your Method of Payment:

[ ]  Check or Money Order (Enclosed)  [ ]  VISA or MASTERCARD **

** Complete the following for Credit Card Transactions:

** ISSUING BANK: _______________________________________________

** CARD NUMBER: ________________________________________________

** NAME AS IT APPEARS ON THE CARD: _____________________________

** EXPIRATION DATE: ____ / ____

**          X_____________________________________________

Signature above authorizes Capital City On-Line to charge the account
noted above for the purpose of registering wcSECURE. Signature is
the card holder of the account, in accordance with the terms of the
card holder agreement.
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