ACCIDENTAL SOFTWARE
       13245 SKIOMAH RD.
       APPLE VALLEY, CA. 92307                       ASP CD-ROM  07/01/93
        -----------------------------------------------------------------
       |  NAME            : ___________________________                  |
       |  ADDRESS         : ___________________________                  |
       |    "             : ___________________________                  |
       |    "             : ___________________________                  |
       |  TODAYS DATE     : ___________________________                  |
        -----------------------------------------------------------------
                                  REGISTER
        -----------------------------------------------------------------
       |      ULTIMATE BLACKJACK PURCHASE & REGISTRATION REQUEST         |
       |                                                                 |
       |   SEND ME THE CURRENT VERSION OF ULTIMATE BLACKJACK ON DISK.    |
       |                                                                 |
       |   ULTIMATE BLACKJACK           $10.00 x (   )   $___________    |
       |                                                                 |
       |   SOUND BLASTER VOICE PACK     $ 5.00 x (   )   $___________    |
       |                                                                 |
       |   SHIPPING AND HANDLING               $ 3.00    $      3.00     |
       |                                                                 |
       |   Total the amounts and enclose        TOTAL    $___________    |
       |   a check or money order as payment.                            |
       |                                                                 |
       |   FOREIGN ORDERS: Please use an international money order       |
       |   and specify only U.S. currency.                               |
       |                                         _____ 360k 5 1/4 DISK   |
       |                                         _____ 1.20 5 1/4 DISK   |
       |                                         _____ 720k 3 1/2 DISK   |
       |                                         _____ 1.44 3 1/2 DISK   |
        -----------------------------------------------------------------
                                   SURVEY
        -----------------------------------------------------------------
       |                      SHAREWARE SURVEY                           |
       |                                                                 |
       |   How did this product come to your attention?                  |
       |                                                                 |
       |   ____ A. From a shareware vendor (name) _____________________  |
       |   ____ B. From a BBS (name) __________________________________  |
       |   ____ C. From a friend                                         |
       |   ____ D. Other (please specify ______________________________  |
       |                                                                 |
       |   ------------------------------------------------------------  |
        -----------------------------------------------------------------
       THANKS