

                               VideoBase Order Form


Number of Registered Copies ($15 each) _____            total $____________

Address _________________________________________    please send all orders to:

        _________________________________________        Vic Freed
                                                         Rt. 3  Box 348-J
        _________________________________________        Reed City, MI  49677

        _________________________________________

Each registered copy will have the name of the registered user on the title screen.  Please write the name of the registered user for each program ordered.

          ____________________________________________________________

          ____________________________________________________________

          ____________________________________________________________


        