Copyright  1999 DECOSoft Company, All Rights Reserved.
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Worm 1.07 ORDER FORM 

Your Full Name: ______________________________________________________
E-mail Address: ______________________________________________________

Mailing Address 
  Street: ____________________________________________________
  City: ______________________________________________________
  State/Province: ____________________________________________
  Zip/Postal code: ___________________________________________
  Country: ___________________________________________________

 Phone Number: _____________________

Software to Order
  Title:  Worm 1.07
  Price:  US$9.75 per one copy of programm
  Amount of copies: ________________
  Total Dollar Amount:  US$ _______________
  I'd like to get FREE registraton, because _________________________
  
  (additional information see at http://www.chat.ru/~egord/games_en.htm )

YES! I would like to register Worm.
I pay the registration fee of $9.75 US dollars, 


Signature _____________________________    Date _____________


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Send this order form to: dekot@mail.ru

Send a cheque or money order to::
Egor A. Dyukarev
Krasnoarmeyskaya 46-59
Tomsk, 634061
Russia

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Please don't edit the following lines.
Registration Code
