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  1. Name:
  2. Organization:
  3. Address:______________________________________________________________________________________________________________________________________________________________________________________________________________________________
  4.  
  5. Where did you get your copy of ResGenie™?_________________________
  6.  
  7. Do you have an e-mail address? :__________________________________
  8.  
  9. Comments:__________________________________________________________________________________________________________________________________________________________________
  10.  
  11. Price per unit: $10.00 U.S.
  12. Number of units:________
  13. Total Included:__________
  14.  
  15. Would you like to be kept up to date on the latest versions of ResGenie?_______
  16.  
  17. Would you be willing to pay a small additional fee to order a professionally designed set of clip art to go with this stack? (Results of this survey will determine whether this is done or not.)_________________
  18.  
  19. Please mail check or money order to:
  20.  
  21. Mark D. Clark
  22. 12521 Ridgehaven Rd.
  23. Little Rock, AR 72211