AS OF 8-4-94 V5.5

    JS-Field ORDER FORM :    Prices subject to change without notice.

    TO:                      Date: ____________________

        Johnathan Mark Smith
        569 Lamoka Ave.
        Staten Island, NY 10312
        USA

    FROM:
        Name: ____________________________________________________

   [Company]: ____________________________________________________

   Reg. Name: ____________________________________________________
              [Used to register your software, 50 characters max.]

     Address: ____________________________________________________

        City: ____________________________________________________

       State: __________________________ Postal Code: ____________

     Country: __________________________ Phone: __________________

    ========================================================================
    (Choose ONLY ONE of the following JS-Field price schedules)

    SINGLE REGISTRATION for the use of JS-Field
     1 computer  ..........................................___x $20   ______

    INTERNAL SITE LICENSE for the use of JS-Field
     2 or more computers ................................. ___x $30   ______
    ========================================================================
    TOTAL PRODUCTS                                                  $ ______

    Add $3.00 for shipping and handling                          +  $   3.00



                                                     TOTAL ENCLOSED $ ______

    Payment method:  ( ) Cash       ( ) Check       ( ) Money order

    ONE software & documentation diskette included:
    Diskette format (choose one) 5.25" disk ___   3.5" disk ___

   ========================================================================

    AUTHORIZED SIGNATURE: __________________________________________________

    TITLE: __________________________________________  DATE: _______________

    ========================================================================

    1)  How did you find out about JS-Field?

    ( ) Friend, co-worker       ( ) BBS ______________________________

    ( ) Other ________________________________________________________

    2)  What do you like about JS-Field?  (check as many as apply)

    ( ) Pricing                 ( ) Features
    ( ) Support                 ( ) Documentation
    ( ) Other ________________________________________________________

    TERMS:

    Payment may be made by check, US POSTAL Money Order or International
    Money Order in USA funds drawn on a USA bank made out to
    Johnathan Mark Smith.

    Please allow a 4 to 6 weeks for delivery.