Order Form
Prices good through 12/96, subject to change thereafter.

__________________________________________________________________________
(Name)

__________________________________________________________________________
(Company)

__________________________________________________________________________
(Street1)

__________________________________________________________________________
(Street2)

__________________________________________________________________________
(Town)                                   (State)              (Zip)

__________________________________________________________________________
(Telephone)                   (Fax)               (Country if outside USA)

Shipping is $4.00 for your entire order, whether you order 1 or 100 items.


 QUANTITY  ITEM                               PRICE EACH          TOTAL
--------------------------------------------------------------------------
           The Lights Go Down 3.5" diskette   US  $25.00    US$
--------------------------------------------------------------------------
           The Lights Go Down 5.25" diskettes US  $27.00    US$
--------------------------------------------------------------------------
           Shipping                           US  $ 4.00    US$   4.00
--------------------------------------------------------------------------
           TAX  (NYS residents only)               ___ %    US$
--------------------------------------------------------------------------
                                                  TOTAL:    US$
                                                          ================
Prices good through 12/96, 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 hear about this program. Thanks for your 
cooperation.
[] BBS - which one?______________________________________
[] Friend    [] retail store package    [] CD-ROM
[] magazine - which one?_________________________________
[] other - ______________________________________________



Send your order to
     Pik A Program (tm)
     13 Saint Marks Place
     NY, NY  10003
     USA
     
     TOLL FREE (ORDERS ONLY) 1-800-TOREGISTER  (1-800-867-3447)
     Telephone (212) 598-4939, Fax (212) 228-5879
     Compuserve: 74777,3233 (GO PIKAPRO)
     Internet: 74777.3233@compuserve.com

Please make your check or postal order payable to Pik A Program