





              Program Name: GS Caller ID      

                   Version: ______



            Your Full Name: _____________________________________

      Your Mailing Address: _____________________________________

          City, State, Zip: _____________________________________





         Your Phone Number:  (______)  __________________________

        Your Email Address:   InterNet: _________________________

                               FidoNet: _________________________

            ____________________ Other: _________________________





                                   (only if different than mailing address)

       Your Street Address: _____________________________________

          City, State, Zip: _____________________________________







      Enclosed is my payment for $20.00 for the registration and key file 
      relating to the program listed above. I understand that no warrantees 
      are expressed or implied as to the functionality or usefulness of 
      this program in respect to any project outside of the direct scope 
      of this program.



      _____________________________________________    ________________
                      SIGNATURE                              DATE


                 Complete and mail to:   Glenn J. Schworak
                                         1710 Lee St SE
                                         Salem, OR 97302
