JChat v1.0 Registration Form

Please print all info below clearly!

Name ______________________________________________________________

Street Address ____________________________________________________
        
City _________________________________ State _____ ZIP ____________

Home/Voice Phone Number (_____)___________________

BBS/Data Phone Number   (_____)___________________

FidoNet Address (if applicable) __________________

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Due to the nature of the registration keys (96 bit key file), they cannot 
be sent via conventional US Mail.  There are currently 3 ways for you to 
receive your registration key.  Please check one:
         __
        |__|   FidoNet Crash Mail (by address above)
         __
        |__|   Call my BBS to pick up your key  (fill out info below)
         __
        |__|   Call to your BBS <to upload key> (refer to info below)


For second option, you must fill out the information below:

Account Name  __________________________  (Jason Hall if 3rd option)

Account Password _______________________  (JCHATKEY if 3rd option)

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JChat Registration Cost:  $5.00

Amount Enclosed ____________________


Please make all checks and money orders payable to:

Jason Hall
757 Covey Ct.
Belpre, OH 45714-2035

Thank you for your continued support!!


Office use only!!!  Do NOT write below this line!
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Date Registration Received ___/___/___

Method Key Sent by:   1   2   3     Sent on ___/___/___

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