Binkley Gate SOFTWARE REGISTRATION APPLICATION
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       Binkley Gate Software                           MAIL to: Jeff Binkley
                                                       ASA Compucom
      (614) 476-4058 (14.4)                            12 Westerville Sq. Suite 359
      (614) 476-9876 (28.8)                            Westerville, Ohio 43081
      (614) 476-9876 (FAX)

       FIRST and LAST NAME _______________________________________________

       ADDRESS             _______________________________________________

       CITY, STATE, ZIP    _________________________   ____    ___________

       VOICE/BBS PHONE #   _________________________/_____________________

       YOUR BBS NAME       _______________________________________________


      Binkley Gate registration  ($20)           Quantity    _______________
      
      Add ($3) if youd like a diskette mailed    Quantity    _______________
      Specify Size  3.5"  , 5.25"

      Add 5.75% Ohio sales tax for Ohio orders only           _______________

              TOTAL Enclosed__________(U.S. FUNDS ONLY !!!!) (Do not send cash)

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For Visa, Mastercard and American Express registrations please fill this section out.

Please circle your card type.

Amex/VISA/MC Number ________________________________EXP _____/_______

Signature___________________________________________