---------------------------------------------- EXTEND-A-NAME 2.10 Registration and Payment Form ---------------------------------------------- To order your registered version of World Software Corporation, please fill out the form below. Use your street address only, please. To order direct, call (201)444-3228. Date: _____________ Name: _____________________________ Title: ___________________ Company: ________________________________________________________ Address: ________________________________________________________ _________________________________________________________________ City: ___________________________________________________________ State/Country: ________________________ Zip: ____________________ Phone Work: (_____) _____ - ______ Home: (_____) _____ - ______ Method of payment: Please complete the form below and check-off the applicable payment option. New Jersey State residents must add sales tax. CHECKS AND MONEY ORDERS MUST BE DRAWN ON U.S. ACCOUNTS ONLY. +----------+------------------------------+----------+----------+ | | | Cost | Total | | Quantity | Description | per unit | Cost | +==========+==============================+==========+==========+ | | EXTEND-A-NAME Version 2.10 | $25.00 | | +==========+==============================+==========+==========+ | New Jersey residents add sales tax | | +-----------------------------------------+----------+ | Shipping: $4.00 (Overseas is $15.00) | | +-----------------------------------------+==========+ TOTAL | | Please indicate diskette format: [ ] 5.25 +==========+ [ ] 3.5 [ ] Check with order [ ] Money Order [ ] MasterCard [ ] VISA Credit card #:______________________________ Exp. Date: ____/____ Signature: ______________________________________________________ Cardholder's name: ______________________________________________ Cardholder's address: ___________________________________________ (If different from above) ***************************************************************** Send all items to: World Software Corporation EXTEND-A-NAME REGISTRATION 124 Prospect Street Ridgewood, NJ 07450 USA