Registration Form

EISSINGER UTILITIES, Version 3.0



           
                   Item          Quantity X Price = Total
           
                   Disk   3.5"   ________ 
           
                   Disk   5.25"  ________ 
           
                   License       ________ x   $25 = _________ 
           
                   Total                            =========
           
           
                     Name : ________________________________
           
                Address 1 : ________________________________
           
                Address 2 : ________________________________
           
           City/State/Zip : ________________________________
           
                    Phone : (_______)  _____________________
           
           
           Please Mail, with Payment to . . .
                  Michael A. Eissinger
                  Microcomputer Consultant
                  346 East Cedar
                  Hanford, CA 93230