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*                                                                           *
*             R  O  M  U  L  A  N   A L I E N  C R E A T O R  V 2.0         *
*                                                                           *
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*                                                                           *
*   Your Name:  __________________________________________________________  *
*                Last                    First                      MI      *
*                                                                           *
*   Your BBS Name: _____________________________________                    *
*                                                                           *
*   BBS SoftWare:  _____________________________________                    *
*                                                                           *
*   Your Address:  _____________________________________                    *
*                   Street or Box                                           *
*                                                                           *
*                                                                           *
*                  ______________________________________________           *
*                   City                ST                 Zip              *
*                                                                           *
*                                                                           *
*   Your Voice Phone:  (______)________--____________                       *
*                                                                           *
*                                                                           *
*   Your Data Phone:  (______)________--____________                        *
*                                                                           *
*                                                                           *
*   Paying with Check or Money Order (Check ONE)?                           *
*                                                                           *
*                  CHECK [ ]                  MONEY ORDER [ ]               *
*                                                                           *
*               #_________                                                  *
*                                                                           *
*                                                                           *
*   Signature:  ________________________________________                    *
*   I hereby state that the funds given are in good standing.               *
*                                                                           *
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*                                                                           *
*                        Mail $5.00 US dollars to:                          *
*                               William Counts                              *
*                               PSC 1 BOX 1056                              *
*                              ANDREWS AFB DC  20331                        *
*                                                                           *
*              THANK YOU FOR SUPPORTING THE SHAREWARE CONCEPT!              *
*                                                                           *
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