                   -=> Order Form for Clomp's Password Locker 1.0 <=-

 Contact Information
    Name               :
    Company            :
    Address            :
    City, State, Zip   :
    Home Phone Number  :   (   )____-_______
    Work Phone Number  :   (   )____-_______
    E-mail (REQUIRED)  :


  Misc. Optional Information
    Age                :
    Internet URL       : http://
    Non-U.S. Country   :

 Reg. Code for Password Locker 1.0 ...............................-=>  $15.99
 [ ] I am a student.  Enclose a photocopy of your school id ......-=>  -$1.59
    (10% student discount)

 Subtotal ........................................................-=>  $_____

 [ ] Missouri Residents: Add 6.25% Sales Tax......................-=> +$_____
 [ ] California Residents: Add 8.5% Sales Tax.....................-=> +$_____

 Total ...........................................................-=>  $_____

 Comments / Suggestions / Bugs Found:

 ____________________________________________________________________________

 ____________________________________________________________________________

 ____________________________________________________________________________

 Please mail my registration code on:
 [ ] U.S. Postal mail on a 3.5" (HD 1.44 MB) IBM Floppy Disk
 [ ] U.S. Postal mail on a 3.5" (DD  7.2 KB) IBM Floppy Disk
 [ ] E-mail to: ______________________
 [ ] Zip Disk (add $20 for disk or include one)

 Make check or money order payable to: Clomp Corp.
 Mail this form, photocopy of student id (if applicable), and payment to:
          Clomp Corp.
          Software Registrations Dept.
          560 Powell St. #605 
          San Francisco, CA 94108

 Product Updates: http://www.clomp.com

 Thank you for using this product!
