
          Registration form for  Crazy Larry's Online Art Products
         __________________________________________________________
           Crazy Larry's Online Art is owned by Bitwise Computers

         All sales are final! By using any CLOA wcCode product, you
         take full responsibility for the use of said products. Any
         damage that occurs from the use, or misuse of any products
         whether accidental or coincidental is your responsibility.
         __________________________________________________________
             Please complete this form legibly and acurrately

         Your name as entered in wcConfig:  _______________________

         Your BBS  as entered in wcConfig:  _______________________

         Your BBS registration code from wcConfig:  ____-__________

         Your BBS  phone number:  _________________________________

         Your Home phone number:  _________________________________

         Address:  _________________________________  Apt #: ______

         City:  _____________________  State/Province: ____________

         Zip/Postal code: __________________  Country: ____________
         __________________________________________________________
             Select which products would you like to register:

         [ ] PULL DOWN MENUS  wcCode Pull-Down menu system   $15.00
         [ ] POWER LOGON      wcCode Configurable logon      $15.00
         [ ] WINDOWED CHAT    wcCode Sysop-User chat module  $10.00
         __________________________________________________________
                  How would you like to pay for your order?

         [ ] Check or money order (enclosed)
         [ ] Credit Card -
                               Name on Card _______________________  
             [ ] Visa           Card Number _____-_____-_____-_____      
             [ ] Master Card        Expires ___/___                                    

         Include $1.00 handling fee per item for credit card orders
         __________________________________________________________
         How would you like to receive your registration number(s)?

         [ ] Via internet at address: _____________________________
         [ ] Self Addressed Stamped Evelope (enclosed)

         __________________________________________________________
           FOR OFFICE       Received _________  Key(s) __________  
           USE ONLY!    Check Number _________    Date __________
                       Credit Card Athorization number __________
         __________________________________________________________
          Make checks or money orders payable to BITWISE COMPUTERS
               and send it along with this completed form to:

                              BITWISE COMPUTERS
                                P.O. Box 829
                            Forest Grove,  Oregon
                                 97116-0829
