TO:                        FROM:

Seraline P/L                   Name: __________________________________
P.O. Box 282
Ryde                      (Company): __________________________________
NSW 2112
AUSTRALIA                   Address: __________________________________

                               City: __________________________________
Date: __________
                 State, Postal Code: __________________________________

                          Country:   __________________________________

Daytime
Phone #: _________________________  FAX #: ____________________________


Email:   _________________________


How you received Frenetic (eg BBS, CD, friend): _______________________

FRENETIC(TM) SCREENSAVER version 3.2

LICENSE FOR INDIVIDUAL USE (diskette not included)                US$10

Other currencies:

UK:        7 pounds
Australia: $15.00

CHECK TOTAL (your currency)                                     ________

Please make checks payable to: Seraline Pty Ltd.

On receipt of your payment, a registration code will be emailed, faxed,
or mailed to you. Note that no diskette is mailed. Contact us for price
details if you require the latest version sent on diskette.