------------------------------------------------------------------------- | Balazs Rozsa / Pik A Program Order Form | ------------------------------------------------------------------------- THANK YOU FOR REGISTERING YOUR SHAREWARE! Important: If you are ordering by mail, e-mail, or fax, please completely fill out this form and send it in. If you are sending a check or money order, please make sure that payment is made in US funds drawn on a US bank. Technical support is not available from Pik A Program. For any technical help, please contact Balazs Rozsa directly online: CompuServe: 100324,3131 Internet: 100324.3131@compuserve.com For registered users of any program which Pik A Program distributes, who do not already have access to Compuserve, we can supply a FREE Compuserve membership with a $15.00 usage credit and access software. This is much more than enough online time to have your technical support questions answered, and still have some fun! You may mail, fax, e-mail, or phone in your order. Please send the completed registration form, along with payment to Pik A Program, Inc. ------------------------------------------------------------------------- | Balazs Rozsa/Pik A Program ORDER FORM | ------------------------------------------------------------------------- Pik A Program (tm) TOLL FREE (ORDERS ONLY) 1-800-TOREGISTER 13 Saint Marks Place (867-3447) NY, NY 10003 Telephone (212) 598-4939 USA Fax (212) 228-5879 Compuserve: 74777,3233 Internet: 74777.3233@compuserve.com __________________________________________________________________________ (Name) __________________________________________________________________________ (Company) __________________________________________________________________________ (Street1) __________________________________________________________________________ (Street2) __________________________________________________________________________ (Town) (State) (Zip) __________________________________________________________________________ (Telephone) (Fax) (Country if outside USA) __________________________________________________________________________ (e-mail address) Shipping $4.00 for your entire order, whether you order 1 or 100 items. QUANTITY ITEM PRICE EACH TOTAL -------------------------------------------------------------------------- Action SuperCross US $29.95 US$ -------------------------------------------------------------------------- Shipping US $ 4.00 US$ 4.00 -------------------------------------------------------------------------- TAX (NYS residents only) ___ % US$ -------------------------------------------------------------------------- TOTAL: US$ ================ Orders are sent on 3.5" diskettes unless otherwise requested. Prices good through 12/97, subject to change thereafter. I am paying by: ( ) CHECK ( ) VISACARD ( ) MASTERCARD ( ) AMERICAN EXPRESS ( ) CASH (by registered mail only, please) ( ) DISCOVER CARD Number ______-______-______-______ Exp. date ___-___ ________________________________________________ ______-______-______ (Signature) (Date) We would appreciate it if you would tell us where did you first heard about this program. Thanks for your cooperation. [] BBS/Online service - which one?______________________________________ [] Internet - which site?______________________________________ [] Friend [] retail store package [] CD-ROM ______________________ [] magazine - which one?_________________________________ [] other - ______________________________________________ ------------------------------------------------------------------------- | Ordering on-line through Compuserve SWREG service | ------------------------------------------------------------------------- You can order Action SuperCross on-line using Compuserve SWREG service. The registration fee will be added to your CIS bill and you will get the registered version of the program by Compuserve e-mail soon after ordering. GO SWREG, choose 'Register a program' from the menu, and select the 12817 product ID. ------------------------------------------------------------------------- | Ordering on-line via Pik A Program's secure WWW registration system | ------------------------------------------------------------------------- You can order Action SuperCross from the secure web site www.pik.com. Pik A Program's secure WWW registration system is capable of taking your order, then, while you are still connected, process the credit card, and allow a download of the registered version of the game.