RegSoft.com Mail Order Form Please fill in the form below completely, and Mail it with a Check or Money Order, payable in US Dollars to: RegSoft.com Inc. PMB201 10820 Abbotts Bridge Road Suite 220 Duluth, GA 30097 * If you choose to fill it out by hand, PLEASE PRINT LEGIBLY * Important: If you have access to the Internet, please go to our website, www.elastomania.com, click on order and fill in and mail the form you find there. Then you will have the option to get the program by downloading it from the web instead of getting it on a floppy disk by mail. This is much faster and you don't have to pay the $5 shipping fee. If you mail in this form, your only choice is that the program is shipped on a 1.44MB 3.5" disk to you. Product ID: 16624 Program Name: Elasto Mania Registration Fee with floppy diskette delivery: $14.95 Billing Information: Please be sure your email address is correct! This is how you will receive your registration confirmation (the game will be shipped to you on a floppy disk). Compuserve users please use a period (.) instead of a comma (,) 1234.567 not 1234,567 Email Address: ____________________________________________________ Full Name: ________________________________________________________ Company Name: _____________________________________________________ Billing Address: __________________________________________________ ___________________________________________________________________ ___________________________________________________________________ City: _____________________________________________________________ State/province: ___________________________________________________ Country: __________________________________________________________ Zip/postal Code: __________________________________________________ Phone Number: _____________________________________________________ Fax Number: _______________________________________________________ Notify me of updates to the RegSoft.com Shareware site: ___________ Georgia Residents Please include 7% Sales Tax Payment Type: [ ] Visa [ ] MasterCard [ ] American Express [ ] Discover (Novus) [ ] Check / Money Order Card Number: _____________________ Exp Date: _______/_______ * Thank you for your order! *
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