Please print this form and follow the instructions below:
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                          DDH Software Order Form
                        Email, Mail, Fax, or Phone to:

                               [DDH Software]
                            ATTN: David Haupert
                               PO Box 970971
                          Boca Raton, Fl 33497-0971
                               (561) 470-2133
                         email: sales@ddhsoftware.com
                        web: http://www.ddhsoftware.com
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First Name:____________________      Last Name:____________________________

Street
Address:_____________________________________________________________

City:________________________________________________________________

State:____________________ Zip Code:___________ Country:_____________

Day Phone: _______________________  Eve Phone:_______________________

Email address:_____________________________________________

Type of Computer you own:
[ ] IBM-PC compatible  [ ] Apple Macintosh  [ ] Other:________________

Pilot owned:
[ ] Pilot 1000     [ ] Pilot 5000     [ ] PalmPilot Personal
[ ] PalmPilot Professional   [ ] None

Memory installed:
[ ] 128K     [ ] 512K    [ ] 1 MB   [ ] 2 MB   [ ] 3MB   [ ] Other:________

Choose Payment Option:
[ ] *Check or *Money Order (enclosed)  [ ] First Virtual  [ ] Credit Card
* Please make payable to: David Haupert

Choose shipping option:  [ ] Via Email      [ ] Via Mail (*US Only)

If Registering by First Virtual:
First Virtual Pin #:__________________________________

If Registering by Credit Card:
Check one:  [ ] Visa    [ ] MasterCard

Account Holder full name (as it appears on card) :
__________________________________________

Credit Card Account #:
_______________________________________________________________

Expiration Date (MM/YY): ___/___

Product(s) Available:
Enter the Quantity of each item you would like to register:
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Quantity Description                     # Words      Price (US $)   Total
____     Translate + Danish Language     3787         $12.00         $
____     Translate + Dutch Language      8633         $12.00         $
____     Translate + Esperanto Language  8665         $12.00         $
____     Translate + Finnish Language    3228         $12.00         $
____     Translate + French Language     7135         $12.00         $
____     Translate + German Language     9335         $12.00         $
____     Translate + Hungarian Language  1200         $12.00         $
____     Translate + Icelandic Language  1106         $12.00         $
____     Translate + Indonesian Language 1155         $12.00         $
____     Translate + Italian Language    2275/3526    $12.00         $
____     Translate + Japanese Language   1806/9752*   $12.00         $
         *Shipped with free larger EDICT_S database
____     Translate + Latin Language      745          $12.00         $
____     Translate + Mandarin Language   1491         $12.00         $
____     Translate + Norwegian Language  1936         $12.00         $
____     Translate + Portuguese Language 2353         $12.00         $
____     Translate + Spanish Language    3666/8083    $12.00         $
____     Hangman + Wheel of Treasure     N/A          $12.00         $
____     Thesaurus                       52,255       $15.00         $
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                                                Subtotal             $
                                                Less any Discount  - $
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                                                Total amount         $

I authorize David Haupert to charge the appropriate amount as noted above
for providing the appropriate software as listed above.  Software will be
shipped or emailed as noted above.  I understand that the software is
released as shareware and it is protected by copyright from illegal use
and/or copying.  I also understand that the software is released as is, and
that author is not responsible for any damages that may occur from the use
or misuse of this software.

Signature:_________________________________________ Date:______________