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                        SIMPLE DOS REGISTRATION FORM
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PLEASE TYPE OR PRINT.  

Mail To:  Tim Hayes
          P.O. Box 580
          East Chicago, IN 46312

NAME:_____________________________________             DATE:_______________

ADDRESS:________________________________________
        ________________________________________
        ________________________________________

CITY:_____________________  STATE:_______  ZIP CODE:____________


_______ Copies of Simple DOS at $8.00 Each    $________

Please send my order on [ ] 3.5" 720K  or  [ ] 5.25" 360K

                                         Subtotal $ __________

                              Shipping & Handling  + 2.00

                               Total (U.S. Funds) $ __________

Payment by:  [ ] Cash     [ ] Check       [ ] Money Order
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