UWG-ULTRA WAS ARCADE ORDER FORM (C) 1996 (Author E-Mail: tipstir@aol.com)

For the shareware individual who is registering more Ultra Arcade Games

Qty. Unit   Total  Code#  Description

(__)  $5.00 $__|__ UWG41 BabyBrats Ultra Play Room Deluxe

(__)  $5.00 $__|__ UWG42 BabyBrats Ultra Backyard Deluxe

(__)  $5.00 $__|__ UWG48 Ultra City Bomber

(__)  $5.00 $__|__ UWG50 C.Y.B.E.R Centurion Defender

(__)  $5.00 $__|__ UWG51 Ultra Enemy Tank T-284

(__)  $5.00 $__|__ UWG53 Ultra DinoEgg

(__)  $5.00 $__|__ UWG56 Ultra BB-16 Deluxe

(__)  $5.00 $__|__ UWG57 Ultra FF-21  Deluxe

Domestic (U.S.A Customers) Type of Payment (Check one) (_)Check   (_)M/O   (_)Postal M/O

(_)Get all 8 Ultra game titles for $15 dollars. S+h is included in this offer!

Add $1.55 to cover the shipping and handling for domestic first class mail orders of 1 to 4 games.

Add $3.10 to cover the shipping and handling for domestic first class mail orders of 5 to 8 games.

Foreign (Other countries) Type of Payment (Check one) (_)Check  (_)Foreign  [M/O in US funds]

(_)Get all 8 Ultra game titles for $20 US dollars. S+h is included in this offer!

Add $5.00 to cover the shipping and handling for foreign airmail orders of 1 to 8 games.

|Total amount enclosed in this order: ($____.____)|

Please make your Check or Money Order Payable in US FUNDS  to: ALBERT C. ASHTON

Mail this order form to:

ALBERT C. ASHTON

19395 LIBERTY RD

BOCA RATON, FL  33434-2644

USA

[Please fill-out below then mail back this form to the above address.]

ORDERED BY:                 CUSTOMER INFORMATION              DATE:_____/_____/_____

Contact Name:_________________________________________________________________         _____|

Individual or Company Name:_________________________________________________________        _|

Address:_______________________________________________________________________________|

City:___________________________              State:___________Zip:____________ ---_________________|

Country other than the U.S.A:________________________________________|

Phone No: (         )                                       Fax No: (       )______________________|

Email  or Web page address:__________________________________________________________________|

Special Instructions or Comments:_______________________________________________________________|

US.FORM_SHW REV.1996 ULTRA ARCADE

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Thank You For Your Order!