                    PicLogon ORDER FORM
________________________________________________________

ALL INFORMATION REQUIRED EXCEPT FIELDS DENOTED BY [opt]

First Name: _____________________________________

Last Name:  _____________________________________

Credit Card Number: _____________________________
               (Visa/Master Card/Discover)

Credit Card Expiration Date: (YY/MM)  _____/_____

E-mail address:
____________________________________________________
(Note: the product will be sent to your e-mail address)

Billing Address:

Company: ________________________________________[opt]

Street Address:________________________________________

Apartment or Suite #: _____________

City: _________________________________________________

State (US only): ______________________________________

Zip/Postal Code: _____________

Country: ______________________________________________

Daytime Phone: _______________________________[opt]

Fax Number:    _______________________________[opt]


Product Name: PicLogon 1.0 (20 user license)

Price @ :                     20 $US

Quantity:               ________

Total Price:            ________ $US


PLEASE NOTE THAT YOUR CREDIT CARD STATEMENT WILL SHOW 'WWW.SOFT-
SHOP.COM'
