My Little Realm Order Form
          
          Name 
          Last: ___________________________  First: ________________  M.I. ___
                   
          Address: ___________________________________________________________

          City: _________________________________________  State: ____________

          Zip: ________________ Home Phone: (________) _______________________

          * Note:  All programs must be sent to the above address.
          ____________________________________________________________________
          Name of the owner of the bonus program, if different from above.
          
          Last: ___________________________  First: ________________  M.I. ___
          ____________________________________________________________________

          ____  Yes!  Please rush me the programs I've selected below.

                Stand-alone Programs           Qty    Price         Total
             
                  Calling Cards               _____    $20        _________
                  Charge Card                 _____    $20        _________
                  Checking                    _____    $20        _________
                  Private Library             _____    $20        _________
                  Public Library              _____    $20        _________
                  Read More                   _____    $20        _________
                  Records of the Realm        _____    $20        _________
                  Savings                     _____    $20        _________
          ____________________________________________________________________
          
          ____  I'd rather save $100!  Please rush me the entire My Little 
                Realm system for only $60.
                                         
          My Little Realm/The System   _______   at  $60/system   _________
          ____________________________________________________________________
             
                                              Shipping/Handling   __$5.00__
             
                                                       Subtotal   _________
           
                   New Jersey residents please add 6% sales tax   _________
             
                                       Total amount of purchase   _________
          ____________________________________________________________________
          
          Disk size:   _____   5 1/4"   _____   3 1/2"    (Disks are DS/DD)
          ____________________________________________________________________
          
          Please send your check or money order to:  
                              
                              John L. Salisbury 
                              22 Church Street #103, Suite 376
                              Ramsey, New Jersey 07446

          Checks and money orders must be drawn on U.S. banks in U.S. funds.
          Sorry, phone orders cannot be accepted.  Prices subject to change.
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