
	     -------------------------------------------------------
	      RAY'S NUMBERS GAME v1.1 ORDER FORM - CREDIT CARDS ONLY
	     -------------------------------------------------------
			Product Number: 15280
     	Please complete all sections of this form  in full in order to
     	process  your  order.  YOU MUST OBTAIN  THE APPROPRIATE LICENCE
     	FOR YOUR USE.
	-----------------------------------------------------------------
	What type of licence do you require?  Please tick one box. 
 
     	For use on a SINGLE computer 			  $20 - 00   [ ]
     	Site license for up to 6 machines	          $50 - 00   [ ]
	Site license for more than 6 machines	          $75 - 00   [ ]
	-----------------------------------------------------------------
	Purchasers Details:

	I wish to pay by: Mastercard[ ]   Visa[ ]   Amex[ ]  Discover[ ] 

 	Name exactly as on card: ___________________________________

 	Card Number:_____________________________ Expiry Date___________

 	Authorized Signature:  ______________________________________

	Delivery Address ________________________________

			 ________________________________	
		
			 ________________________________
	
	Email(if available)  ____________________________________

	------------------------------------------------------------------
	Do you wish to receive registration by:  Email [  ]	Post [  ]
	------------------------------------------------------------------
	Either FAX this form to PsL at 713-524-6398 or mail it to them at 
	P.O.Box 35705, Houston, Texas 77235-5705, USA
	
	The PsL address/numbers are for ORDERS only.   If you have ANY 
	queries regarding Ray's Numbers Game address them to the author.
	------------------------------------------------------------------
    	I understand that Ray's Numbers Game is provided AS IS and without 
  	warranty of any kind, either express or implied. I confirm that it
    	will be used according to the licence  and that the licensed copy
	will not be made available to any third parties.
	  	
    		Purchaser's Printed Name:  .............................
    	
  	        Signature: ...........................
 