APPLICATION FOR RECEIVING COMMISSION CHECKS
     
     
     COMPANY NAME: ..................................................
     
     NAME: ................................. DATE OF BIRTH: .........
     
     ADDRESS: .......................................................
     
     CITY: ..........................................................
     
     STATE: .................................. ZIP: .................
     
     PHONE: ....................................
     
     Have you EVER ordered a copy of "The Reseller's Source Kit?" .........
                                           (Don't have to)
     
                                One REGISTERED copy of RESALE94.ZIP  $2.00
     
                       California orders PLEASE add your sales tax  ........
     
                                              SHIPPING POSTAGE PAID ...n/a..
     
                       Specify: (3.5 72K) disk or (5.25 360K) disk: ........
     
     
      Make check or money order out to: DISK-COUNT DATA
     
                          Disk-Count Data
                          P.O. Box 277482
                          Sacramento, CA. 95827-7482
                          916-381-2851 24-HR BBS