                First Name:
                 Last Name:
             Date of Birth:
            Street Address:
               Apt. Number:
                      City:
                     State:
                  Zip Code:
              Zip Code Ext:
                Home Phone:
                Work Phone:

                   Library:

                   Product  Price Total
                   -------- ----- -----
                   WAPSWGT    $10
                   WAPSVAL    $10
                   WAPSCALC   $10
                                  -----
                   Grand Total:

                   Make checks payable to Userware.
  
                   Send to:
  
                            UserWare / Shazam Software
                            4 Falcon Lane East
                            Fairport, NY 14450
