ORDER FORM


Please complete the following and mail the form and registration
fee to:

                           Attn: PACK2DSK
                             IntelliSys
                            PO BOX 21233
                          Roanoke, VA 24018


Name: _______________________________________________________________

Company: ____________________________________________________________

Address: ____________________________________________________________

         ____________________________________________________________

City, State, Zip: ___________________________________________________

Country: ____________________________________________________________

Daytime Phone Number: _______________________________________________


                                         Diskette format (check one):

                                       5.25" disk (__) 3.5" disk (__)

                                     Number of copies of at $20 each:

                                           ____ x $20.00 = $_________

                                Shipping & handling for each package:

                                   ____ packages x $5.00 = $_________

                                           Total enclosed: $_________



                                TERMS

Check or Money Order drawn on a United States bank in United States
funds. All licenses are prepaid only. All orders outside of the
United States must be prepaid.



                            QUESTIONNAIRE



Please complete the following questionnaire.


Where did you obtain your copy of this program?







Which version do you have? __________________________________________


To help us provide you with the highest quality product possible,
what comments or suggestions do you have about this program or
IntelliSys?