

                      TO:  Franklin Service Systems
                           P O Box 202
                           Roxbury, CT  06783




                                               date           
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                                          name

                                                                  
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                                         address

                                                                  
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                                city            state     zip

                                                                  
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                      areacode    phone          alternate phone

                     type of computer                             
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                         5 1/4 disk               3 1/2 " disk     
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                     hard disk y/n?           capacity?           
                                      _____             __________

                     where did you learn of DEX-i-cal?/comments
                                                                   
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