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+ TOTAL SYSTEM SOLUTIONS, INC.                                 +
+ 1530 East 18th Street, Brooklyn NY 11230                     +
+ Voice: 718-375-2997 FAX: 718-375-6261 CompuServe: 70154,2463 +
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Registration & Order Forms 
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Please complete & send this form along with payment. 
You may print and send via regular mail or Fax. Or if
you prefer, send this text file via e-mail.


From what source did you receive your copy of Text Jumper?
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[ ] CompuServe  Forum Name: ________________________________

[ ] BIX  [ ] Genie  [ ] AOL  [ ] Other BBS ___________________________

[ ] Catalog ______________________  [ ] Other _________________________


Name:  ________________________________________________

Company: _______________________________________________

Title: _________________________________________________

Street:  _______________________________________________

City: __________________________________________________

State: ________________________   ZIP: __________________

Country: ________________________________________________


HOME PHONE: ________________________________
             (include area/country code)

WORK PHONE: ________________________________

FAX: _______________________________________

E-Mail Service:______________________ E-Mail Address:______________________
         

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## PAYMENT ##
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Text Jumper Registration Fee:  $14.95


Date Ordered:  Month ________  Day _____  Year ______

Credit Card Orders 
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Credit card orders may be sent via mail, E-Mail, FAX, or telephone.
   

Please Check:  [ ] MasterCard  [ ] Visa   
                                                    
Credit Card Number:  _________________________________
                     
Expiration Date:  Month __________  Year _____________


Name As It Appears On Card: _________________________________________


Cardholder's Signature:  ____________________________________________
                          

______ Number of Copies @ 14.95 per Copy = $ ___________
  
   New York State residents add Sales Tax: $ ___________
                                                    
                 Total Amount Authorized:  $ ___________


Checks or Money orders
-----------------------
Please make checks and money orders payable to: 
Total System Solutions, Inc.
(Payments should be made in U.S. currency only.)


______ Number of Copies @ 14.95 per Copy = $ ___________

   New York State residents add Sales Tax: $ ___________
                                                    
                   Total Amount Enclosed:  $ ___________