WinKey Registration Form

			   Please mail to:
			    DataGem Corp.
			1420 NW Gilman # 2859
			  Issaquah, WA 98027


Name:			________________________________________

Company:		________________________________________

Address:		________________________________________

			________________________________________

City/State/Zip:		_______________________ ___ ____________

Country:		___________________________

Daytime telephone:	___________________________

Current WinKey Version:	___________________________

Date:			___________________________

Medium:  3 1/2 inch diskette ( )   5 1/4 diskette ( )

Payment (US Funds only):

	Check or money order ( ) $15.00		
	COD		     ( ) $20.00
	MasterCard           ( ) $15.00
	Visa 		     ( ) $15.00

Credit card number: ____________________________  Expires: ______



Credit card signature: ___________________________

Purchase price from above: _____ copies @ ____________ = ________
					  	     
Washington residents add 8.2% (or ____ %) sales tax:	 ________

Total:							 ________

Comments/Requests: