Note:  Use this form to Register your Perfect Box program.
         Turn on your printer, and from the DOS prompt type:
                    TYPE REGISTER.DOC > PRN     (press Return)

     **********     Perfect Box 4.5x Registration Form.  *********
     
      Date:           ____________________

      Name:           ____________________________________________

      Company Name:   ____________________________________________

      Use this Company Name for ID screens in Perfect Box?  Yes  No

      Position:       ____________________________________________
     
      Street address: ____________________________________________
      (P. O. Box)
                      ____________________________________________
      
      City:           ____________________________  State: _______

      Country         ________________________

      Zip :           ______ - _____   Phone # (    )-____-_______

      Where did you find out about Perfect Box? __________________

      ____________________________________________________________

      Choose Media Type:   360 K (5.25 inch)  -or-  720 K (3.5 inch)

      Type of Computer/hardware:  __________________________________
    
      ______________________________________________________________

      Comments or specific program modifications : _________________

      ______________________________________________________________

      ______________________________________________________________
     
      ______________________________________________________________

     Please add me to your Registered User list and send me a copy
     of the most current release of Perfect Box!  

     For use on :
     1 - 5 computers ... @ $40.00 each.   ___ copies x $40 = $ ________
     6 -20 computers ... @ $35.00 each.   ___ copies x $35 = $ ________
     Over 20 computers : Write for current Site License or Custom
                         distribution options.

                                       Total Fee included  : $ ________

       Send Company/Personal Check or Money Order (sorry no charge cards)
       for the total amount shown above in U.S. funds drawn on a U.S.
       institution to :    
                           Warren A. Merkel
                           2851 Newcomb Ct.
                           Orlando, FL 32826-3411