WinHacker 95 Resistration Form

===Personal Information (* - Required)=============================

*Name:		___________________________________________________

Company:	___________________________________________________

*Address:	___________________________________________________

		___________________________________________________

*City:		___________________________________________________

*State:		____________		*ZIP:     _______-_____

Phone:		(____)____-______	Fax:	  (____)____-______

Email address:	___________________________

Where did you hear about or get WinHacker 95?

	( ) Internet - Web page or FTP site: ______________________
	( ) BBS		( ) From another person
	( ) Other _________________________________________________


===Order Information===============================================

	WinHacker 95 Version 1.0	@ $9.95 each	$__________

	Shipping overseas		@ $6.00		$__________

					Subtotal	$__________

	Michigan residents add 6% sales tax		$__________

					Total		$__________


Media type (check one):		( ) 3.5"	( ) 5 1/4"

- Checks and money orders only.  
- Make check payable to Robert Wojciechowski Jr.

Send orders to:

	Robert Wojciechowski Jr.
	P.O. Box 431
	Davisburg, MI 48350-1223

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