                      MergeEm Order Form

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Your Name: _____________________________________________

Note:	Type/print your name and company below EXACTLY as it appears
in the Registration
	dialog in the Help Menu of the Application.

Registration Dialog Name:
_____________________________________________

Registration Dialog
Company:__________________________________________

Please type or print clearly the following information:

Address: __________________________________________________________

City: _________________________________      State: _____      Zip:
__________

E-Mail Address: _______________________________

Check the programs you wish to Register.

Search/Replace String:				    _____  $15.00
HTML Merge:					            _____  $35.00
MergeEm:					            _____  $35.00
Both Search/Replace & MergeEm:			_____  $45.00
Both Search/Replace & HTML Merge:		_____  $45.00
Search/Replace, MergeEm, & HTML Merge:	_____  $60.00

I have enclosed a 
___ Check	___Money Order		___ Cash	(Check One)

Preferred Registration Code delivery:
___ Mail	___ E-mail	(Check One)

Platform:
___ Win95	___ WinNT

Please include a self addressed envelope for mail delivery to speed
up the response.
_____________________________________________________________________
Please make checks payable to Richard Floersch.
Mail this form and your check, cash, or money order to:

Richard Floersch
7307 W 89th Terr
Overland Park, Ks	66212
_____________________________________________________________________

