Order Form             Bingo Mathness  Registration
 Please provide the following information:      Date    _____________

 ____________________________________________________________________
 Your name

 _______________________________       ______________________________
 Street                                City     State/Pr    Zip

 _____________    __________________      ___________________________
  Country          Phone                   Fax (optional)

 ____________________________________________________________________
 E-mail address(-es) (optional)

 ____________________________________________________________________
 Where did you find Bingo Mathness ? (optional)
 ____________________________________________________________________
 Comments or suggestions?

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 Item              Qty              Price $ 19.95 Total
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 Shipping & Handling  (International $7)                    $  5.00
 British Columbia  residents please add 7.%  P.S.T.         $______
 Canadian  residents please add 7.%  G.S.T                  $______

                          GRAND TOTAL:                      $______
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 Payment Method:  (marking X)
               Check __    Money Order __     VISA ___    MC ___
 ___------____________________________________________________________
  VISA/Mastercard Card #      Expiration Date:  Month/Year     ___/___

 ______________________         _______________________
  Signature                      Cardholder Name
If VISA or Mastercard, you can phone in order or  mail or fax this order form
with your card number and expiration date.
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 Please mail your completed registration form and **payment** to:
Nissen Ventures              Tel 1-604-436-5501
P.O.Box 637                  Fax 1-604-430-2210
Surrey BC V3T 5L9           Compuserve  102261,114
Canada                       E-mail: 102261.114@compuserve.com