SanitySoft 
Order Form
(Please Print this page)


Product                          Bingo Hall   1.0

Price                            10.00


Personal Information:

NAME                    __________________________      *

Email Address           __________________________      *

ADDRESS:                __________________________      * (If Requesting

                        __________________________         a CD )       
                                
                        __________________________ 
                               
                        __________________________                                       

                                     
PHONE #                _____ - ______ - __________




                


CD Request           [     ]  - Please check this box and add 5.00 
                                to your order if you would like a CD.  



SIGNATURE        ____________________________________________       *





Please send a check payable to Ray Malone to P.O Box 1485 Hedgesville,
Wv 25427. Once payment is received a registration code will be E-mailed 
to the listed email address and if a CD is requested, it will be
mailed to the address listed above.        

* = Required Field  ( if required fields are missing, illegible, 
                      or invalid your order may be delayed or never
                      received  )        

