SIMPLE LOCK ORDER FORM

Please print clearly.  There are no taxes or postage fees for ordering Simple LOCK.
Simple LOCK orders are processed on arrival at Dead Broke
Software and sent out that same day.  You have the options of having SL sent by
the Post or by E-Mail.  E-Mail is the fastest way to receive Simple LOCK.  By
E-Mail, the SL Setup files are sent by MIME format.  This format is compatible with
America Online, Z-Mail, Eudora, any most other mail readers.  

We can only accept check or money orders.  No credit card orders please.  If you 
are from a country other than the United States, please indicate the check/money
order amount by writing 10 U.S. dollars.  If you want to send cash, you are welcome 
to, but please be aware that cash can easily be stolen by Post Office employees.  
If you have any questions about ordering Simple LOCK, please feel free to E-Mail us 
at dbsoftware@aol.com.


QUANTITY           ITEM                                                    PRICE

________________________________________________________________

_______              Simple LOCK v2.0 for Windows 95           $10.00

_______              Simple LOCK for Macinotosh                   $10.00   
       


Name: __________________________________________________________

Street: _____________________________________________ Apt #: ______

City: __________________________________________________________

State: ______________________ Zip Code/Postal Code: ________________

Country: ____________________ Telephone: (_____) __________________

Fax: (_____) _________________

Internet E-Mail Address: __________________________________________



AMOUNT ENCLOSED   $______.00       

PAYMENT METHOD:     ____ Check      ____M.O.       ___ Cash

SENDING OPTION:       ____ E-Mail       ____ Diskette

DISKETTE SIZE:           ____ 3.5           ____ 5.25


 
(Make Check or Money Order payable to Anthony Cocciolo)


Mail this page and your Check or Money Order to:

                                   ANTHONY COCCIOLO
                                   13886 PHEASANT KNOLL LANE
                                   MORENO VALLEY, CA 92553
     
