Product:  QuickPop 2.0
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Registration information:
[1]
[2]
[3]
Phone/FAX:   [4]       [5]

Email:   [6]

Comments:   [7]  

Payment Method:   [8][9][10][11]

Price per copy............:   $10.00
Number of copies........:   [12]
Quantity Discount.......:   [13]
Send Latest?...............:   [14]
Sales Tax (CA Only)...:   [15]

Total Due....................:   [16]

[17]
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Print this form and send your check, money order (made payable to “John V. Holder”) or cash to:

John V. Holder                                                           Email addresses (AOL is preferred):
2862 Lowell Street                                                   America Online:  JohnHolder
Eureka, CA  95501-4315                                         Internet...........:  JohnHolder@aol.com
USA                                                                            CompuServe....:  75040,1126

FAX:  (707) 443-3813