GoCIS Charges Order Form
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Please make check or money order payable to Jack J McDowell
and send, along with this form, to

                       Jack J McDowell
                       164 Fifth St. N.E.
                       Atlanta, GA 30308

GoCIS Charges is $12.95 plus $2.55 shipping and handling.
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    _________ GoCIS Charges registrations @ $12.95 each   _______
              ~~~~~~~~~~~~~
    Shipping & Handling:  $2.55 per registration           _______

                                  Total enclosed           _______


    Name__________________________________________________________

    Address_______________________________________________________

    City____________________State/Prov.___________________________

    Zip/Postal________________  Country___________________________

    Phone______________________   Email___________________________
 
    Disk size (circle one):   5.25"    3.5"