ORDER FORM - USE THIS FORM TO ORDER BY CHECK OR MONEY ORDER.

Program: My Personal Diary for Windows 95
Version: 5.5
________________________________________________________________
Send To:                   From: (PLEASE TYPE OR PRINT CLEARLY)

Chris Maresco                    _______________________________
105 Bayview Ave.
E. Patchogue NY 11772            _______________________________

                                 _______________________________

                          Phone: _______________________________


Source:
                                        Number of copies: ______
 COMPUSERVE ___
        AOL ___                                         X $24.95
    PRODIGY ___
        BBS _________________  OUTSIDE US & CANADA ADD $5.00 S&H
     VENDOR _________________
      OTHER _________________           Send this amount: $_____
                                    (Checks MUST be in US funds
                                             drawn on a US bank)


Media Type: 5 1/4" HD____  3 1/2" HD____  OTHER (specify) ______

Computer: ____________________      Printer: ___________________

Please supply your e-mail address if you would like to receive
update notification by e-mail.

E-mail address: ________________________________________________

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