DiskTrak for Windows Ver. 2.90 Order Form
             =========================================

   Name: _______________________________________________

Company: _______________________________________________

Address: _______________________________________________

         _______________________________________________  

   City: _______________________________   State: ______   

Country: _________________  ZIP/Postal Code: ___________


Method of payment:


       ____ check for $40.00 (US) made payable to Peninsula Software 


       ____ Visa or MasterCard credit card ($40.00 total)
 
           Credit Card type:  ____ Visa    ____ Mastercard

           Credit Card Number: ___________________________

           Expiration Date: _______________

           Signature: _____________________  Date: ______________
         


Comment: _________________________________________________

         _________________________________________________

         _________________________________________________



Send to:     Peninsula Software
             28510 Blythewood Drive
             Palos Verdes CA 90275



         -----> Thank you for supporting shareware <-----