ORDER FORM		 			Jeroboam Version 1.2

Full Name      _______________________________________________

(Your name as you would like it to appear in the "about" screen.)

Address   _______________________________________________
          _______________________________________________

City ___________________  State/Area __________  Zip / Post Code _______

Country   _____________________    Phone     ________________________

E-mail address : ____________________________________

Please send me the last version of jeroboam in the following format :

Qty   Format   Price+Shipping   Price+Shipping  Price+Shipping
                   (US$)              ()             (FF)

__     3.5"       $15 + 5           9 + 3       FF 90 + 30

__    5.25"       $15 + 5           9 + 3       FF 90 + 30

Please pay by Cheque, International Money Order or Eurocheque.

  Signature:
                        _______________________________________


  Your signature means you agree to the following terms :

AS  A  JEROBOAM USER  I  ACCEPT THE FOLLOWING WARRANTY CONDITIONS :

"THIS SOFTWARE AND THE ACCOMPANYING FILES ARE SOLD "AS IS" AND WITHOUT 
WARRANTIES AS TO PERFORMANCE OF MERCHANTABILITY OR ANY  OTHER WARRANTIES
WHETHER EXPRESSED OR IMPLIED. THE USER MUST ASSUME THE ENTIRE RISK FOR 
USING THE PROGRAM.  ANY LIABILITY OF THE SELLER WILL BE LIMITED 
EXCLUSIVELY TO PRODUCT  REPLACEMENT OR REFUND OF PURCHASE PRICE."

Your signature also means you agree that your registration key will not 
be given to anybody else, except your family.

Send me this order form with your payment to the following address :

Mr Philippe Querrec
Appt 5094
19B rue de Brest
35000 RENNES
France

or Philippe.Querrec@wanadoo.fr

----ooooo$$$ooooo----

Some questions : Where did you get your copy of Jeroboam?

  BBS                   [  ] which one : ___________________________
  Compuserve            [  ] which forum : __________________________
  Disk or CD-ROM        [  ] which editor : _______________
  Magazine              [  ] which one : ______________
  A friend              [  ] how did he get it  : ________________________
  Other                 [  ] precise : ____________________________

What Windows version did you use ?

Windows 3.1 [ ]   Windows 3.11 [  ]   OS2 Win [  ]   Windows 95 [  ]


Questionnaire to help me improve Jeroboam :

  Suggestions :

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

________________________________________________________________________

How can Jeroboam be improved?

________________________________________________________________________

________________________________________________________________________

Strong points :

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The latest shareware version of Jeroboam is available over the Internet
network :

http://perso.wanadoo.fr/Philippe.Querrec/
