REGISTRATION / ORDER FORM  (Blackjack SW)      
                                  03/30/94
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   Check one.....      (Ultimate Blackjack SW-3.0)         Check one.....
                                                                      
      (Prices shown include $3.00 shipping and handling)
   ___ Blackjack ------------------------------ ($13.00)   Disk type.....     
   ___ Blackjack + Voice pack ----------------- ($18.00)      
   ___ Blackjack + Baccarat ------------------- ($21.00)   ___ 720K (3.50 DD)
   ___ Blackjack + Baccarat + Voice packs ----- ($26.00)                     
   ___ Blackjack + Gin ------------------------ ($21.00)   ___ 1.44 (3.50 HD)
   ___ Blackjack + Gin + Voice packs ---------- ($26.00)
   ___ Blackjack + Baccarat + Gin ------------- ($29.00)   ___ 1.20 (5.25 HD)
   ___ Blackjack + Baccarat + Gin + Voice packs ($34.00)
   (NOTE: Add $2.00 postage for foreign orders other than Canada)
                                    
                                 Software Total $________
                          Ca. Sales tax @ 7.75% $________ (California only)
                                    Grand Total $________
   
   Send check or money order           Your Name:_________________________
   to......
   ACCIDENTAL SOFTWARE                   Address:_________________________
   13245 SKIOMAH RD.                                                         
   APPLE VALLEY, CA. 92308               Address:_________________________ 
                                                                           
   Phone Orders (619) 247-2804    City,State,Zip:_________________________
   
   FOREIGN ORDERS: Send International money order (U.S. currency) or check 
   drawn on a U.S. bank or MasterCard / VISA information.
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   For your convenience, we accept MasterCard or Visa. You may charge the 
   amount of your purchase.  If you decide to charge, send this sheet to 
   ACCIDENTAL SOFTWARE with the following information or call 619-247-2804.
   
   Check one....
    __                 VISA or MasterCard number __________________________
   |__| VISA          
                       Expiration date ____________________________________
    __                                                              
   |__| MasterCard     Card holders name __________________________________
                       
                       Signature __________________________________________

   Phone orders accepted between 8AM and 8PM Pacific Standard Time, Monday
   through Friday.            (619) 247-2804
   Orders are shipped via U.S. mail.               (Ultimate Blackjack 3.0)
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   Shareware Survey:  How did this product come to your attention?
   ___ 1. From a shareware vendor (name) __________________________________.
   ___ 2. From a BBS (name) _______________________________________________.
   ___ 3. From a friend.
   ___ 4. Other (please specify) __________________________________________.
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