R E G I S T R A T I O N   F O R M
---------------------------------

The cost of the Laurel COBOL Maintenance Support System is $25.00.

Please indicate your name and address below:


   NAME: _________________________________________________

ADDRESS: _________________________________________________

         _________________________________________________

         _________________________________________________

Individual users may install the System on as many computers as may exist in
the given household.  Corporate users are requested to register the first 25
installations at each given location (building), but may otherwise install the
package into as many PCs as required.

Make checks payable to: 

                       David Richmond
                       13082 Three Mile Road
                       Lowell, Michigan 49331-9715

                       Phone: (616) 897-8522