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		SIMPLE VIEWER -- REGISTRATION FORM
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  * Send $19.95 (U.S.) cash, certified check or money order to:

		Eric DeBrosse
		P.O. Box 61
		Middletown, Ohio 45042


	(Please type or print clearly!)

NAME: __________________________________________

E-MAIL: ________________________________________

SECONDARY E-MAIL: ______________________________	(optional)



ADDRESS: _______________________________________	(optional)

CITY/STATE: ____________________________________	(optional)

ZIP CODE: ______________________________________	(optional)

COUNTRY: _______________________________________	(optional)

PHONE NUMBER: __________________________________	(optional)



AMOUNT ENCLOSED: _______________________________

CHECK NUMBER: __________________________________	(optional)

DELIVERY METHOD:  ___ E-MAIL  (and/or)  ___ U.S. POST OFFICE


  * Include an additional $5.00 to deliver using U.S. Post Office.
  * Stop by our web site to use your credit card on-line.
  * View the file ORDER.TXT for more detailed information.

		________________________

		DeBrosse Consulting, LLC
		     eric@blown.com
		  http://www.blown.com
		________________________

Revision: 5/27/2000
