                       -=> Black Jack Registration Form <=-
       
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        First Name :___________________Last Name :_______________________
       
           Address :_________________________________APT # :_____________
       
              City :_______________________State :_______ZIP :___________
       
        Home Phone :(    )____-________   INTERNET :_____________________
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        BBS NAME :___________________________BBS Software :______________
       
        BBS Phone :(    )____-________Fido Net/Node :____:______/________
       
        Maximum Baud Rate :_________________Modem Type :_________________
       
        Math CO-PROCESSOR ( )YES  ( )NO   Computer Type :________________
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        There are three ways of receiving your registration.  You can
        choose from US Mail, Remote or via INTERNET.  If you do choose
        REMOTE please fill out the REMOTE REGISTRATION SECTION.
        If you choose mail I will send you your key file plus the
        current door(s) you registerd.
       
        REMOTE REGISTRATION :   (USA ONLY)
        Please make an account with the following information so
        that I can upload the registration code to you.
                 ACCOUNT NAME : DANNY DAVIS
             ACCOUNT PASSWORD :                (PRINT PLEASE)
                ACCOUNT PHONE : 209-325-0278
             ACCOUNT BIRTHDAY : 07/26/65
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           BLACK JACK REGISTRATION : QTY____ x $15.50 = $________________
       
        CHOOSE ONE BELOW :
       
        ( ) US MAIL ADD                        $ 3.00 = $_____________S/H
           Please Select a Disk Size :
           ( ) 720k       ( ) 360k
           ( ) 1.2        ( ) 1.44
       
        ( ) REMOTE (USA ONLY) ADD              $ 2.00 = $_____________L/D
       
        ( ) INTERNET EMAIL                        N/C
  
        CA RESIDENT add SALES TAX                       $________________
       
            Disk with all the latest doors ADD    $1.00 $________________
       
         TOTAL DUE (US FUNDS ONLY)                      $________________
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        Send Check or Money Order to :
             Danny Davis
             1126 Birch Avenue
             Clovis, California 93611
       
                CHECKS WILL HOLD UP THE ORDER TILL THEY CLEAR THE BANK
       
       
                          SPECIAL REGISTRATION OFFER
       
            If you register multiple doors you may take advantage of
            the special pricing shown below.  See DOOR.TXT file for
            more information on the other doors.
       
            
            Select The Doors You Wish To Register :
            ~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
            ( ) Hang-Man                       ( ) Thirteen
            ( ) Yahtzee                        ( ) Match 15
            ( ) Word Scramble                  ( ) Black Jack
            ( ) Solitaire                      ( ) Video Poker
            ( ) Tuts Revenge                   ( ) Draw Poker
            ( ) Four Leaf Clover               ( ) Seven Towers
            ( ) Solitaire Concentration        ( ) Phrase Craze
            ( ) Keno
       
            QTY = Number of Doors Checked
       
                          2 - 4 Doors
                                    QTY____ x $14.50 = $ ________________
       
                          5 - 14 Doors
                                    QTY____ x $12.50 = $ ________________
       
                          All 15 Doors
                                    QTY____ x $10.00 = $ ________________
       
            ( ) US MAIL              ADD      $ 3.00 = $ _____________S/H
                Please Select a Disk Size :
                ( ) 720k       ( ) 360k
                ( ) 1.2        ( ) 1.44
       
            ( ) REMOTE or FIDONET    ADD      $ 2.00 = $ _____________L/D
       
            CA residents add sales tax               + $ ________________
       
           Disk with all the latest doors    ADD $1.00 $_________________
       
                          Total US FUNDS DUE         = $ ________________
