Pentomino Order Form
                ====================

       Name: __________________________________________________

    Company: __________________________________________________

    Address: __________________________________________________

       City: ___________________________ State: _______________

    Country: _______________________ Post/Zip Code: ___________


Your Email Address: ___________________________________________

Where did you obtain
    the program from:  ________________________________________

Payment:
=======
All amounts are in Australian Dollars. The exchange rate is
approximately US$0.75 for each AU$1.00 (ie. AU$20 is about US$15)

PAYMENTS MUST BE IN AUSTRALIAN DOLLARS PAYABLE AT AN AUSTRALIAN BANK.
(Cash is discouraged due to lack of security, but is acceptable)

   Pentomino program:                   ____ copies  = $_______
     1       license   no discount. ($20.00)
     2 - 5   licenses 20% discount. ($16.00 each copy)
     6 - 20  licenses 35% discount. ($13.00 each copy)
     21 +    licenses 50% discount. ($10.00 each copy)

   If you wish to receive the source code (see "Registering"
   in Help) then add one of the following shipping options:
      Internet Email   ............  No Charge
      Within Australia ............  $5.00
      Overseas         ............  $7.00             $_______

                                                Total  $_______

If you are receiving the source code through the
post then specify your disk size:
                                 ____ 5.25" ____ 3.5"

Payments:
========
Make your payment made out to Stephen Balogh, and send it to:

     PO Box 414
     Caulfield East
     Melbourne
     AUSTRALIA     3145

Comments:
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If you have access to the Internet then I can be contacted at:
   steve@monu6.cc.monash.edu.au  or  steve@monash.edu.au