Order form for FamilyData registration

Name  ________________________________________________________________

Address  _____________________________________________________________

______________________________________________________________________

City/town ____________________________________________________________

Province/state _______________________Post/zip code __________________

Country ______________________________________________________________

Daytime phone number _________________________________________________

FAX number ___________________________________________________________

E-mail address _______________________________________________________

Payment: [ ] Check  [ ] Postal money order

Checks must be drawn on a US bank; all funds are US dollars.

[ ] No shipping: Check here if you wish to have the registered version of FamilyData Emailed to you. 

I'd like to order/register the following shareware:

[ ] FamilyData			                               $10.00

Shipping and handling (Not applicable to Email shipping)     $ 5.00 			
						                        _________
TOTAL (US DOLLARS)




Mail this form to:  	Don Sabelhaus
				109 1/2 West Spring Street
				LaGrange, IN 46761
