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                          REGISTRATION AND ORDER FORM
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Mail to:
                               GoldPax Software
                                 P.O. Box 1576
                           Royal Oak, MI 48068-1576

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                                          PRICE       PRICE
  PRODUCT                         QTY      EACH       EXTENDED
  -----------------------------   ---      -----      ---------

  Single User Object License      ___      $35.00     $ _______

  Single User Object License
  with Source Code                ___      $60.00     $ _______

  Registered User Obtaining
  Source Code                     ___      $35.00     $ _______

    Registration Number ______________________________
                               ( Required )

  Multi-User Corporate License    ___     $500.00     $ _______


                                         SUBTOTAL     $ _______

  Michigan orders, add sales tax (4%)                 $ _______


                                            TOTAL     $ _______

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  Name:    _______________________________________________________________

  Address: _______________________________________________________________

           _______________________________________________________________

  City:    _______________________________________________________________

  State:   ____  Zip: ______________ Phone: (______) - ______ ____________

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Comments:

  ___________________________________________________________________________

  ___________________________________________________________________________

  ___________________________________________________________________________

  ___________________________________________________________________________

  ___________________________________________________________________________

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