                       Funduc Software, Inc. 
   Patch Creator for Windows Mail & Fax Registration Forms

As part of the registration, you will also receive free updates and
customer support (by E-MAIL) for a year.  Updates are sent to
registered customers as they become available.  They incorporate
your suggestions so please send them.  If you have problems
receiving the program or need customer support, contact us directly
by E-MAIL at support@funduc.com.

Credit Card Registrations: Several options are available. 

 1) Secure Internet Order: If you have a secure Web browser such 
    as Netscape or Internet Explorer, you may register by credit 
    card via a secure Web transaction from our web site at: 
    http://www.funduc.com. 

 2) Via Fax: To register using a credit card via fax, complete the
    form below and fax the completed order to (734) 462-1886.
    Please write clearly or type when you complete the form.  Fax
    orders with email delivery are typically processed within one
    business day.  Allow 7-10 days for postal deliveries. Write
    support@funduc.com if you have a question about your order.

 3) Phone Registrations: Call (734) 462-1552 to order using a credit
    card.  Please specify that the order is for Patch Creator.
    Phone orders with email delivery are typically processed within
    one business day.  Allow 7-10 days for postal deliveries. Write
    support@funduc.com if you have a question about your order.
    
Ordering by check: To order by check, complete the form below and
  mail the form and a check to Funduc Software Inc., P.O. Box
  530904, Livonia, MI 48153 USA.  Please write clearly or type when
  you complete the form.  Please allow 7-10 days for check order
  processing and then contact support@funduc.com if you did not
  receive the program.  Payments must be in US dollars drawn on a US
  bank or international postal money order in US dollars.


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                 FUNDUC SOFTWARE, INC. FAX/MAIL ORDER

   Complete and print this form.  Fax it to (734) 462-1886 or
   mail the completed form and a check to 

                     Funduc Software Inc.
                        P.O. Box 530904 
                     Livonia, MI 48153 USA

NOTE: Payments must be in US dollars drawn on a US bank or an
international postal money order in US dollars.

=================================================================
      PATCH CREATOR FOR WINDOWS FAX/MAIL ORDER
License             Price ($US)   Quantity        Amount
--------------------------------------------------------------
1+ computers        $ 75.00          ________    $________

            Michigan residents add 6% sales tax  $________

Preferred Shipping Method
                          3.5 disk (US) $5 S&H   $________
                    3.5 disk (overseas) $8 S&H   $________
                                    Email (Free) $______0_

                                  Total Payment  $________

Credit Card (Check One): Visa[  ]              MasterCard[  ]   
                         American Express[  ]  Discover[  ]
Your name as it  
appears on the card: _________________________________________

 Credit card number: _________________________________________

    Expiration date: ____________________________

Billing address as it appears on your credit card statement:

  Street Address: ____________________________________________

  Street Address: ____________________________________________

City, State, Zip: ____________________________________________

         Country: ______________________________

Authorized Signature:  _______________________________________
                       (As it appears on the back of your card)

             Date: _________________


       Your Name: ____________________________________________

  Street Address: ____________________________________________

  Street Address: ____________________________________________

City, State, Zip: ____________________________________________

         Country: ______________________________

Day Phone Number: ______________________________

Eve Phone Number: ______________________________

      Fax Number: ______________________________

  E-MAIL Address: ____________________________________________
                      (example: janedoe@youraddress.com)

==================================================================

How did you hear about Patch Creator?


Comments:

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