P R I M E   B A S E   D O O R   R E G I S T R A T I O N   F O R M

   TO:  William Rountree                           Date___/___/___
        7806 Lisa Dr.            
        Apt # 203       
        Norfolk, Va.  23518

       (Please use capitalization and punctuation where necessary.)
 FROM:  SysOp Name: _______________________________________________
        BBS Name: _________________________________________________
        Address: __________________________________________________
        City: ______________________ State: __________ ZIP: _______
        Voice: (   ) _________________ BBS: (   ) _________________
        BBS Software: _____________________ BBS Hours: ____________
        Baud Rates:__________________ Fidonet Address: ____________

                       Current versions as of 06/15/95

  Doors             VERSION   PRICE      Doors               VERSION   PRICE      
  -----             -------   -----      -----               -------   -----
__Adventurer's Maze.. 3.00 ..$20.00    __Murder Mansion........2.92 ..$15.00
__Space Race..........2.91 ..$15.00    __BBS Putt Putt.........1.91 ..$15.00
__I Remember That...!.2.92 ..$15.00    __In-Between Cards......1.92 ..$10.00!
__Wagering In-Beteen..1.92 ..$10.00!   __Dragon Door...........3.30 ..$10.00!
__Criss-Cross.........1.92 ..$15.00    __Word Criss Cross......2.10 ..$15.00
__Bible Trivia........1.20 ..$10.00    __5 Card Stud...........1.20 ..$10.00!
__High-Low Cards......1.01 ..$10.00    __Classified Ads........1.01 ..$10.00
__Poker Solitaire.....1.02 ..$10.00!   __Mine Field............2.10 ..$15.00
__Star Trek Crypto....1.10 ..$15.00    __Accordion Solitaire...1.01 ..$10.00!
__Puzzle..............1.12 ..$10.00    __Klondike Solitaire....1.01 ..$10.00!
__Golf Solitaire......1.02 ..$10.00!   __Cribbage Solitarie....1.20...$10.00!
__Calcula.Solitaire...1.10 ..$10.00!   __Solitaire Package............$40.00 
__Lunar Lander........1.10 ..$10.00      (Includes: Poker, Golf, Calculation,
__Word Search.........1.02 ..$10.00       Accordion, Klondike, Cribbage)
__Adventurer's Maze...Beta ..$20.00

!=Price Reduced 4/18/95  
 
 Subtotal (Column 1)         ______      Subtotal (Column 2)          ______

  ________ Subtotal (Column 1)

+ ________ Subtotal (Column 2)

- ________ Discounts: Order 2 at the same time.
           Order 2= $2.00, 3= $4.00, 4= $6.00, 5= 8.00, 6=10.00, etc...

+ ________ $ 2.00: Call your BBS and leave you a message with the registation
             number. SIGN ON: William Rountree PASSWORD:_____________________

+ ________ $ 5.00: Include with the registraion number, a copy of all my 
             current programs.  Three 3 1/2" diskettes. 

= ________ Total Inclosed (U.S. Funds only, please.)

* Credit Card Processing is available online at Prime Base (804)587-4289/4382.
  (Visa, MasterCard, American Express and Electronic Transfer from Checking.)