WINCOIN REGISTRATION FORM

Please print and return this form with your payment by check
for the amount indicated below to:
(Hand drawn fascimilies are accepted)

    Bob Stech
    5454 Kellogg Ct.
    Willoughby, Ohio 44094


Registration Fees
-----------------------------------------------------
[ ] WINCOIN v1.0                               $39.00
    Register me for Wincoin and send me
    my registration code and the latest
    version.  Also include the remaining
    Master Coin Lists.


    Disk size _______ 5 1/4"  _______ 3 1/2"


Name ________________________________________________

Address _____________________________________________

City ___________________ State ________Zip___________


    Where did you get your copy of WINCOIN?

    ______________________________________


Suggestions or Comments:

_________________________________________________________

_________________________________________________________

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