Console 1.1 Registration Form

To order by check send this order form and a check to
MDMA Software, 5410 Highberry Woods Road, Midlothian, VA 23112-6390.
Payments must be in US dollars drawn on a US bank.

Console personal Copy    ____    copies at $29  each = ______

Console Site License     ____    copies at $199 each = ______

                         Total payment                 ______

Prices guaranteed through December 1995.

Console is shipped on 3.5" disks only.

            Name: ______________________ Date:___________

         Company: _______________________________________

         Address: _______________________________________

City, State, Zip: _______________________________________

         Country: _______________________________________

       Day Phone: ______________  Eve:  _________________

Electronic Mail address: ________________________________

How did you hear about Console? _________________________

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