REGISTRATION FORM  Screen Saver Version 4.3                           12
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    Registration fee:  $20.00


            Date: ____/____/____

            Name: ________________________________________

    Company Name: ________________________________________
     (optional)

         Address: ________________________________________

            City: ____________________  State: ____  Zip: __________

   Daytime phone: (______) _________________  Ext: _______

   Evening phone: (______) _________________  Ext: _______


Make of Computer: _____________________ Model: ____________

   Installed RAM: _________         Disk type: [ ] 5.25"   [ ] 3.5"



    TERMS:  No credit cards, CODs.
            Make checks payable to: Tom R. Donnelly
            Checks drawn on a U.S. bank in U.S. funds.
            International bank or postal money orders in U.S. funds.


   Attach check and mail to:

   Tom R. Donnelly
   P.O. Box 3856
   San Dimas, CA  91773