ORDER FORM		 	Jeroboam Version 3.04

Full Name      ________________________________________

(Your name as you would like it to appear in the "about" 
screen.)

Address   _____________________________________________
          _____________________________________________

City ____________________    Zip / Post Code __________

Country   _____________________    Phone  _____________

E-mail address : ______________________________________

Please send me my registration key in the following format :

Format     Price+Sh     Price+Sh     Price+Sh     Price+Sh
             (US$)        (£)          (FF)        (Euro)

[ ]  Email   $ 15        £ 3          FF 90         E 14

[ ]  3.5"    $ 15 + 5    £ 9 + 3      FF 90 + 30    E 14+4


Please pay by Cheque, International Money Order or 
Eurocheque.

Signature: _______________________________________

Your signature means you agree to the following terms :

AS  A  JEROBOAM USER  I  ACCEPT THE FOLLOWING WARRANTY 
CONDITIONS :

"THIS SOFTWARE AND THE ACCOMPANYING FILES ARE SOLD "AS IS" 
AND WITHOUT WARRANTIES AS TO PERFORMANCE OF MERCHANTABILITY 
OR ANY  OTHER WARRANTIES WHETHER EXPRESSED OR IMPLIED. THE 
USER MUST ASSUME THE ENTIRE RISK FOR USING THE PROGRAM.  
ANY LIABILITY OF THE SELLER WILL BE LIMITED EXCLUSIVELY TO 
PRODUCT REPLACEMENT OR REFUND OF PURCHASE PRICE."

Your signature also means you agree that your registration key 
will not be given to anybody else, except your family.

Send me this order form with your payment to the following address :

Mr Philippe Querrec
Appt 5094
19B rue de Brest
35000 RENNES (France)

or jeroboam@wanadoo.fr

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Some questions : Where did you get your copy of Jeroboam ?

  BBS               [  ] which one : ________________________
  Compuserve        [  ] which forum : ______________________
  Disk or CD-ROM    [  ] which editor : _____________________
  Magazine          [  ] which one : ________________________
  A friend          [  ] how did he get it  : _______________
  Internet          [  ] which site : _______________________
  Internet search   [  ] which motor : _______________________
  Other             [  ] precise : __________________________

Which Windows version are you using ?

Win 3.1 [ ]   Win 3.11 [ ]   Win 95 [ ]   Win 98 [ ]

Questionnaire to help me improve Jeroboam :

Suggestions :
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________

How can Jeroboam be improved ?
_____________________________________________________________
_____________________________________________________________

Strong points :
_____________________________________________________________

The latest shareware version of Jeroboam is available over the 
Internet network : http://pro.wanadoo.fr/philippe.querrec
