ProAna Registration Form ------------------------ Send to: Professional Analyzer c/o RBBS-PC of Fargo P.O. Box 9121 Fargo, ND 58109 Name __________________________________________________ Address __________________________________________________ __________________________________________________ __________________________________________________ Disk format desired (Check one): 5.25"______ 3.5"________ Please check the form of payment: Check/Money order _______ Visa ________ MasterCard _______ Cardholder Name ____________________________________________ Card Number ________________________________________________ Expiration Date ____________ I hereby authorize $20.00 to be charged to my account as specified above. Cardholder Signature ______________________________________ (MUST be signed by cardholder) Date _____________ Thank you for supporting the Shareware concept and ProAna!