                       TRANSCAN (tm) ORDER FORM

      Use this form to order TranScan v5.21 & TranScan Gold v1.xx.

      Shareware Services        Tech Support: 913-232-5584
      1027 SW Randolph Ave      BBS.........: 913-232-5586
      Topeka, Ks. 66604         Orders Only.: 800-578-3061
                                Fido........: 1:281/80

      E-Mail..: transcan@cjnetworks.com
      Internet: http://www.cjnetworks.com/~transcan

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    Name:                                                              
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    Address:                                                           
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    City:                              State:    Zip:                  
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    HOME Phone No:                                                     
   
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                                         Prior to After            
   Qty  Item                             06/30/96 06/30/96  Amount 
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        TranScan v5.21                    $ 35.00  $ 35.00 $       
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        TranScan Gold v1.xx                                        
        (Coming soon. See WIN95.NT.FAQ)   $ 79.95  $ 89.95 $       
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        TranScan Gold v1.xx Upgrade from                           
        TranScan v5. Reg No:____________                           
        (Coming Soon. See WIN95NT.FAQ)    $ 39.95  $ 44.95 $       
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        Auto-Upgrade Plan (12 months)                              
        Order the Auto-Upgrade plan with                           
        your purchase or upgrade and                               
        receive an additional two months                           
        FREE!                             $ 35.00  $ 35.00 $       
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         Shipping                          $  5.00  $  5.00 $       
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         Total                                                $       
   
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    Distributed by: Shareware Services                                 
   
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    MasterCard,Visa,American Express & Discover Payments welcome:      
                                                                       
    Account #:                            Expiration Date:             
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    Signature                                                          
   
          Your registration will be mailed to you upon receipt.
