Order Form
Prices good through 12/98, subject to change thereafter.

__________________________________________________________________________
(Name)

__________________________________________________________________________
(Company)

__________________________________________________________________________
(Street1)

__________________________________________________________________________
(Street2)

__________________________________________________________________________
(Town)                                   (State)              (Zip)

__________________________________________________________________________
(Telephone)                   (Fax)               (Country if outside USA)

Shipping is $4.00 for your entire order, whether you order 1 or 100 items.


 QUANTITY  ITEM                               PRICE EACH          TOTAL
--------------------------------------------------------------------------
           95 Lights Go Down (32 bit version) US  $25.00    US$
           (Registered version w/ 40 modules)
--------------------------------------------------------------------------
           The Lights Go Down (16 bit vers.)  US  $25.00    US$
           (Registered version w/ 40+ modules)
--------------------------------------------------------------------------
           95 Lights Go Down (32 bit version) US  $30.00    US$
           The Lights Go Down (16 bit vers.) 
           Both versions on two diskettes. (*)
--------------------------------------------------------------------------
           Shipping                           US  $ 4.00    US$    4.00
--------------------------------------------------------------------------
           TAX  (NYS residents only)               ___ %    US$
--------------------------------------------------------------------------
                                                  TOTAL:    US$
                                                          ================
(*) Double License: Licensee obtains the right to install the software
    on two computers (eg LapTop and Desktop, or Home and Office).
    This includes the right to use both programs on both computers.
Prices good through 12/98, subject to change thereafter.
I am paying by:
( ) CHECK     ( ) VISACARD    ( ) MASTERCARD     ( ) AMERICAN EXPRESS
( ) CASH  (by registered mail only, please)      ( ) DISCOVER CARD

                     Number ______-______-______-______  Exp. date ___-___

________________________________________________      ______-______-______
(Signature)                                           (Date)

We would appreciate it if you would tell us where did you first hear about this program. Thanks for your 
cooperation.
[] BBS - which one?______________________________________
[] Friend    [] retail store package    [] CD-ROM
[] magazine - which one?_________________________________
[] other - ______________________________________________



Send your order to
     Pik A Program (tm)
     13 Saint Marks Place
     NY, NY  10003
     USA
     
     TOLL FREE (ORDERS ONLY) 1-800-TOREGISTER  (1-800-867-3447)
     Telephone (212) 598-4939, Fax (212) 228-5879
     Compuserve: 74777,3233 (GO PIKAPRO)
     Internet: 74777.3233@compuserve.com

Please make your check or postal order payable to Pik A Program
