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*   Registration for:   Fserv for Windows 95/98 Windows NT.          *
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Name:

Address:

City:

State/Province:

Zip Code:

Country:

Phone number:

E-mail address:

I wish to order ___ copies of Fserv (v3.00) or later for $20.00 US. each.


Payment enclosed (check one):
	
____ Check drawn on a US bank

____ Money order

____ United States cash 

Send this form filled out with payment
totalling US $20.00 to:

	Donald Leavitt
	17940 Gulf Blvd
	Redington, Florida 33708



Thank You!
