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                       REPEAT 5.0  Registration Form         
                   
 
                       Send to:    Steve Edwards  
                                   P.O. Box 14055 
                                   Spokane, WA  99214-0055 
                                   U.S.A. 
 
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        Item                                           Price     Total    
       ͵ 
        REPEAT 5.0 (1 User)                           $10.00  __________  
                                                                          
        REPEAT 5.0 (Unlimited)                        $25.00  __________  
        (1 Disk & 10 Labels) for unlimited PC use                         
                                                                          
        Modification of Code                          $10.00  __________  
                                                                          
        WA resident's sales tax                         8%    __________  
                                                                          
        Shipping (If outside of U.S. and Canada)       $5.00  __________  
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          Total amount of check or money order enclosed:       __________  
        
               
         Name:     ________________________________________________________ 
 
         Company:  ________________________________________________________ 
 
         Address:  ________________________________________________________ 
 
                   ________________________________________________________ 
 
                   ________________________________________________________ 
 
         Phone:    ________________________________________________________ 
 
 
             What size disk do you               Ŀ         Ŀ 
             wish us to send you?         5.25"       3.5"     
             (Please Check One)                            
 
 
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