_______
                                            ____|__     |               (R)
                Just-In-Time             --|       |    |-------------------
    +-------+   Computing                  |   ____|__  |  Association of
   /   J   /    Services                   |  |       |_|  Shareware
  /   C   /     --------------------       |__|   o   |    Professionals
 /   S   /      P.O. Box 4166            -----|   |   |---------------------
+-------+       Ithaca, NY   14852            |___|___|    MEMBER

Voice/Fax: (607) 539-6609  CompuServe: 73020,3205  America On-Line: JSKURKA1

+|              JCSRRS On-Line Registration Form - Page 1 of 2               |+
|           +----------------------------------+        +-------------------+ |
|    Name:  |John Q. Public                    |  Date: |October 21, 1994   | |
|           +----------------------------------+        +-------------------+ |
|           +---------------------------------------------+                   |
| Company   |My Widget Company                            |                   |
|           +---------------------------------------------+                   |
|           +---------------------------------------------+                   |
| Address:  |1234 Main Street                             |                   |
|           +---------------------------------------------+                   |
|           +---------------------------------------------+                   |
|  Line 2:  |Box 1234                                     |                   |
|           +---------------------------------------------+                   |
|           +---------------------------+         +---+        +------------+ |
|    City:  |AnyTown                    |  State: |NY |  Zip:  |12345-1234  | |
|           +---------------------------+         +---+        +------------+ |
|           +------------------+                            +---------------+ |
|   Phone:  |(999) 555-1212    |                  Country:  |USA            | |
|           +------------------+                            +---------------+ |
|           +------------------+                                              |
|     Fax:  |                  |                                              |
|           +------------------+                                              |
|                                                                             |
+-----------------------------------------------------------------------------+
+|              JCSRRS On-Line Registration Form - Page 2 of 2               |+
|                                                 +-------------------------+ |
|  CompuServe, America On-Line or Genie Address:  |100000,10000             | |
|                                                 +-------------------------+ |
|  Method of Payment:  (*) MasterCard                     See DA_SITE.DOC for |
|     ( ) Check        ( ) Visa            + Disk Size +    price schedule    |
|     ( ) Money Order  ( ) AmEx            | ( ) 3.5"  |                +---+ |
|                                          | (*) 5.25" |  # of Copies:  |26 | |
|  Name as it appears on Credit Card:      +-----------+                +---+ |
|    +------------------------------+      + Order Amounts -----------------+ |
|    |John Q. Public                |      |      Per Copy Price:     $5.00 | |
|    +------------------------------+      |    Registration Fee:   $130.00 | |
|  Account Number:                         |  NY State Sales Tax:    $10.40 | |
|    +------------------------------+      |     Shipping Charge:     $3.00 | |
|    |1234-1234-1234-1234           |      |                      --------- | |
|    +------------------------------+      |         Order Total:   $143.40 | |
|  Expiration Date:                        +--------------------------------+ |
|    +------+  Please remember to sign     I got DaMenu from: Genie           |
|    |12-99 |  the Registration Form       Great Program!                     |
|    +------+  before sending it in!                                          |
|                                                                             |
|  Signed: ___________________________                                        |
|                                                                             |
+-----------------------------------------------------------------------------+