




                             USER REGISTRATION FORM
            LoanPmt; COPYRIGHT (C) 1989-1993, DATA LANGUAGE SYSTEMS
                              ALL RIGHTS RESERVED

             To register LoanPmt, complete this form  and the Invoice on
        the following  page and  mail them  with   and your check, money
        order, or charge card information to:

                  Data Language Systems      or    via CompuServe
                  10520 W. SR 32                     72331,240
                  Yorktown, Indiana 47396

        (Please print) DATE: _______________                LoanPmt Ver 2.1
        (Please Check One) ( ) MR., ( ) MS., or ( ) ________
          NAME: _____________________________________________________
        COMPANY: _____________________________________________________
         STREET: _____________________________________________________
           CITY: _____________________  STATE: _______ ZIP: __________
        COUNTRY: _____________________________________________________
          PHONE: (_________)  ________________________________________

        MICROCOMPUTER BRAND: _________________  MODEL:
        __________________
        MONITOR: ( ) Monochrome  ( ) Color
        VIDEO CARD: ( ) MDA  ( ) CGA  ( ) EGA  ( ) MCGA  ( ) VGA
                    ( ) Other __________________________________
        SYSTEM PROCESSOR:
             ( ) 8186  ( ) 8188  ( ) NEC V20  ( ) NEC V30
             ( ) 8086  ( ) 8088  ( ) 80286  ( ) 80386SX  ( ) 80386
             ( ) 80486 ( ) Other _______________________
        MATH COPROCESSOR:
             ( ) 8087  ( ) 80287  ( ) 80387  ( ) Other _________________
        SYSTEM MEMORY ________K.    EMS MEMORY ________K.
        IBM/MS-DOS Ver # __________  EMS Ver # _________
        DISK DRIVES:
             # ___ 5 1/4" Floppy _____ MB, # ___ 3 1/2" Floppy _____ MB.
             # ___ Hard Drives _______ MB.
        PRINTERS:
             ( ) Dot Matrix    ( ) Laser    ( ) Other __________________
             Printer brand name & model# _______________________________
        HOW DID YOU ACQUIRE THIS PROGRAM:
             ( ) BBS ___________________________________________________
             ( ) User Group ____________________________________________
             ( ) Shareware Library _____________________________________
             ( ) From a friend  ( ) Direct from Data Language Systems
             ( ) Other _________________________________________________

        WHAT WOULD YOU LIKE TO SEE ADDED TO THIS PROGRAM?
        ________________________________________________________________
        ________________________________________________________________
        COMMENTS:
        ________________________________________________________________
        ________________________________________________________________




        Remit to: Data Language Systems               INVOICE # 020193
                  10520 W. SR 32
                  Yorktown, IN 47396
                  (317) 759-7367
                  CompuServe 72331,240

        Ship to (please print):

             _________________________________________________

             _________________________________________________

             _________________________________________________

             _________________________________________________

             _________________________________________________
                                                   UNIT
                                                   PRICE
               DESCRIPTION                  QTY   (U.S.$)     TOTAL
        LoanPmt registration.
           (includes free disk and printed _____   $25.00   ___________
            manual of latest version.)
        Add'l LoanPmt distribution disk.   _____    $5.00   ___________
        Add'l LoanPmt manual.              _____   $10.00   ___________
        TPCSHELL distribution disk.        _____    $5.00   ___________
        DIRSRCH distribution disk.         _____    $5.00   ___________
        MOLDWT distribution disk.          _____    $5.00   ___________
             Disk Size: 5.25" (__) or 3.5" (__)
             (5 1/4" will be sent if no selection marked.)

                                                 SUB TOTAL: ___________
        SALES TAX (Indiana Residents only)          5%      ___________
        (If tax exempt, attach Tax Exemption Certificate.)

        Shipping & Handling:                   US - $3.50
                                 Canada, & Mexico - $4.50
                              All other locations - $6.00   ___________

                                                     TOTAL: ___________

        TERMS: All orders must be prepaid IN U.S. FUNDS by Check or
               Money Order (DRAWN ON a U.S. or Canadian BANK), or
               MasterCard or Visa:
        Method of payment (check one):
             ( ) Check  ( ) Money Order  ( ) MasterCard  ( ) Visa
        Charge card  users must  fill out  the following, or phone (317)
        759-7367  (5:00PM-9:00PM   EST).     You  also   may  send   the
        registration,  invoice,   and  charge   card   information   via
        CompuServe E-Mail to 72331,240
        Account No. _______ _______ _______ _______  Exp. Date _______

        Signature: ___________________________________________________
                   (required for all charge cards)
