ORDER FORM FOR LUKE'S SCREEN SAVER I
------------------------------------
To order, print this out, fill it out neatly, include a cheque or
money order and mail to:

Luke Chao
30 Desjardins Crt.
Hamilton, Ontario, Canada
L8S 3R8

Please see the file LUKES_SS.HLP for more information.

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Registation for Luke's Screen Saver 1.01
----------------------------------------

Date (MM/DD/YYYY): ________________

Your registration name or company (appears in About box):

___________________________________

Your real name: ___________________

Company/organization (if applicable):

___________________________________


Your postal address:

___________________________________

___________________________________

___________________________________

___________________________________

___________________________________

Home/Day Phone (including area code):

___________________________________

Work/Evening Phone (optional):

___________________________________

[ ]DON'T send me high density disks
[ ]DON'T put me on your e-mail* mailing list
[ ]I am NOT capable of unzipping ZIP files

[ ]I have registered one of your programs before
If you checked the above, what are your Customer and Invoice IDs from 
your previous order?  (See the top of your invoice for these).


___________________________________

Quantity (registration): __________                   X $10

Discount for multiple orders:                         -_______

Quantity (source code):  __________                   X $25

Discount for multiple orders:                         -_______

Upgrades:
Postal mail (US/Canada): __________                   X $5

Postal mail (Int'l):     __________                   X $10

E-mail*:                 __________

Subtotal:                                             $_______

Shipping and handling (registration and source code only):
( )E-mail*

( )Postal (US/Canada):   __________                   X $5

( )Postal (Int'l):       __________                   X $10


Total (pay this amount in US/CND dollars):            $_______

Payment method:
[ ]Cheque (made payable to "Luke Chao")
[ ]Money order
[ ]Cash (Please send by registered mail)

* If you're using Internet e-mail, what is your e-mail address?

___________________________________

How do you want it to be sent to you (e-mail only)?
( )MIME Attachment		( )UUEncoded

----------------------------
| Questionaire (optional): |
----------------------------

Birthdate (MM/DD/YYYY): ___________

Fax number: _______________________

What languages do you speak?

_________________________________________________________________________

What's your occupation?  ________________________________________________

Your computer (RAM, processor, etc.): ___________________________________

Your operating system(s) (besides DOS):

[ ]Win 3.1 [ ]Win 3.11 [ ]Win 95 [ ]Win NT [ ]OS/2 [ ]Other: ____________

What resolution are you using in Windows?

[ ]640 x 480 [ ]800 x 600 [ ]1024 x 768 [ ]1280 x 1024 [ ]Other: ________

Where did you hear about this and/or where did you get it from?

_________________________________________________________________________

What made you decide to register?

_________________________________________________________________________

Your web page (on the Internet):

http://__________________________________________________________________


Internet e-mail address(s), if different from above:

_________________________________________________________________________

If you would rate this program on a scale of 1 to 10 (10 being the 
highest), what would you give it?  (Circle one of the numbers):

1   2   3   4   5   6   7   8   9   10   Other: ______

What do you like the most/least about this program?

_________________________________________________________________________

On a scale of one to ten, what would you rate your experience with
computers?  (One being beginner):

1   2   3   4   5   6   7   8   9   10   Other: ______

I'm using this program:
[ ]At home [ ]At the office [ ]At school [ ]Other: ______________________

Comments/questions/suggestions, etc. (if you want the program shipped to a 
different address, please say so here):

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________

_________________________________________________________________________
                                                                          
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Thank you for supporting the Shareware concept.  If you want any more
information, you can contact me by Internet e-mail at:
luke.chao@freenet.hamilton.on.ca  
or you can drop by my home page at:
http://www.freenet.hamilton.on.ca/~ab470/

