				O R D E R   F O R M

TO:	ATTN:	FMSG.VBX
	James Domino
	14000 Tahiti Way #309
	Marina del Rey,  CA  90292

FROM:	Name:           ____________________________

	Address:        ____________________________

	                ____________________________

	City:           ____________________________

	State/Zip:      ____________________________

	email Address:  ____________________________

	Phone:          ____________________________

	Fax:            ____________________________

	For delivery:   ___ E-mail to above address

	                ___ Mail to above address
Order:

	QTY  Description                          Unit      Price
	===  ============================    =========	=========

	___  Registration of FMSG.VBX        US $29.95  _________

	     Tax (for California at ??? %)              _________

	     Shipping & Handling                        US $ 5.00		
	         (for Mail order only)

	     T o t a l :                                _________

Payment Method:         ___ Check from United States Bank

MISCELLANEOUS:

	Where did you get your copy if FMSG.VBX:

	____________________________________________

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