                             APPLICATION FORM FOR                              
               EAGLE ENTERPRISE SUBSCRIPTION & SHAREWARE SERVICE               
                                                                               
            Application is subject to approval by Eagle Enterprise             
                                                                               
                                                                               
Mail completed form to:                                    DATE____/____/____  
Eagle Enterprise                                                               
P.O. Box 772                                                                   
Lithia Springs, Ga. 30057                                                      
                                                                               
                          ( PRINT OR TYPE THIS FORM )                          
                                                                               
Name of SySop/Owner: _________________________________________________________ 
                                                                               
Name of BBS: _________________________________________________________________ 
                                                                               
Date of Birth: ____/____/____                                                  
                                                                               
Mailing Address: _____________________________________________________________ 
                                                                               
City: _____________________________ State: ________________ ZIP: _____________ 
                                                                               
Voice: (    ) _______________________    BBS: (    ) _________________________ 
                                                                               
BBS Software: ________________________ Ver______    Hours of Operation: ______ 
                                                                               
Baud Rate: _____________________________________                               
                                                                               
I understand that there is a one time setup fee of $25.00 and that will be     
the only charge for this service other the that stated in the Terms and        
agreement that I have read and understand. I also understand that for any      
reason that my application is not accepted the setup fee will be refunded to   
to me.                                                                         
                                                                               
I have enclosed is my :                                                        
( Please check one of the following )                                          
                                                                               
( )  Check in the amount of $25.00                                             
                                                                               
( )  Money Order in the amount of $25.00                                       
                                                                               
( )  Please Charge the $25.00 setup fee to my                                  
                                                                               
     ( ) Visa   ( ) Mastercard   ( ) Discover   ( ) American Express           
                                                                               
     Card Number: ____________________________________________________________ 
                                                                               
     Exp Date: ____/____                                                       
                                                                               
     Name as it appears on the Card: _________________________________________ 
                                                                               
     Signature: ______________________________________________________________ 
                                                                               
( )  Please deduct $5.00 from each of the first five ( 5 ) orders that I place 
     to be processed by you.                                                   
                                                                               
                                                                               
( )  I wish to have you design my Thank you letter and the Information that    
     will be sent to persons ordering Subscriptions to my BBS or Shareware     
     products. I have completed the attached information for to help you do    
     so.                                                                       
                                                                               
( )  I wish to use my own Thank you letter and Information and have enclosed   
     copy's for you to send to persons ordering Subscriptions to my BBS or     
     Shareware products that I have for sale.                                  
                                                                               
                                                                               
Please give us your legal signature: _________________________________________ 
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