ANIMATED SLOTS REGISTRATION Name ________________________________________ Company ________________________________________ Address ________________________________________ City/State ________________________________________ Zip/Postal Code ________________________________________ Country ________________________________________ Phone ________________________________________ EMAIL ADDRESS ________________________________________ If you include your eMail address, we can send you the registration code immediately. DISK SIZE: ( ) 3-1/2" ( ) CD-ROM I AM ORDERING: ( ) ANIMATED SLOTS ($20) ( ) POWER-PLAY SLOTS ($20) ( ) WILD WIZARD SLOTS ($20) ( ) ANY TWO ABOVE - MARK CHOICES ($30) ( ) ALL THREE SLOT GAMES ($35) INTERNATIONAL ORDERS -------------------- Please add $4.00 for shipping if you live outside North America. For shipping to Canada or Mexico, add $2.00. Payment must be in U.S. funds drawn on a U.S. or Canadian bank. (no charge for shipping within the U.S.) Amount Enclosed: $_________ Make your check or money order payable to ULTISOFT. Mail payment and registration form to: ULTISOFT PO Box 5015 Central Point, OR 97502 USA Payment Method: ___ Check ___ Money Order ___ VISA ___ MasterCard Credit Card Number #_____ - _____ - _____ - _____ expires ____/____ For credit card orders: Call 1-800-925-3147 (U.S. and Canada) 1-541-664-1885 (International) 1-541-664-3403 (FAX)