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                       SysPic 4.00 ORDER FORM

                              Send to:
          Grzegorz Calkowski, Rzedowice, ul.Dobrodzienska 8
                      42-780 Dobrodzien, POLAND
          E-mail: unclemat@irc.pl, gcal@matinf.pcz.czest.pl

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      Name: _______________________________________________________

   Address: _______________________________________________________

      City: ___________________________ State: ____________________

        PC: ___________________________ Country: __________________

    E-mail: _______________________________________________________
    

          Shareware fee sent:     ( ) US$ 10
                                  ( ) 15 DEM
                                  ( ) 10 PLN (Poland only)

          Payment method:         ( ) money included with this mail
                                  ( ) PMO (Postal Money Order)
                                  ( ) Bank transfer

          Send me the keyfile:

          ( ) via E-mail, no extra costs, OR

          ( ) via Snail-mail on DD floppy disk, I add

                                  ( ) US$ 5
                                  ( ) 5 DEM
                                  ( ) 3 PLN (Poland only)

      I have read the Copyright and Distribution notes and do agree.


      Date: _____________________     Signature: __________________