+--------------------------------+
                 | Order Form for ROSE's HackStop |#
                 +--------------------------------+#
                  ##################################

    Name: _______________________________________________________________

    Company (optional): _________________________________________________

    Address: ____________________________________________________________

    City,State,Zip: _____________________________________________________

    Country (blank if Germany): _________________________________________

    Where did you get HackStop from?: ___________________________________

    What version of HackStop do you use?: _______________________________

    Date: __________________    Signature: ______________________________

----------( Version )---------

( )  Normal Registration DM 30,--
     Personalised Text: "Registered version of HS!"
or
( )  Personalised Registration DM 50,--   [please don't use (c) by ...]

     Text (up to 4 lines): ______________________________________________

     ____________________________________________________________________

     Personalised versions are a little bit harder to attack than the
     normal versions. As a bonus all HackStop'ed programs carries your
     personalised text inside!   No text wanted at all: ( )

( )  Please add DM 10,-- extra for outside Europe!

     Disk Size:        (   )   3.5"             (   )   5.25"

---------( Payment )---------

( )  I have enclosed an Eurocheque for registering HackStop. Checks must
     be drawn in DM! Please use non negotiable checks!

( )  I have transfered the money (ONLY in DM) to your account:
     >>  Ralph Roth, Kto: 131 577, BLZ 642 500 60, Kreissparkasse Rottweil

( )  I have enclosed the money in bills at my own risk! Use a registered
     letter if you have doubts! Cash in DM, US$, SFr. & Pounds is accepted.

We can not accept credit cards! Do not send coins!

Please send to                           or FAX to
~~~~~~~~~~~~~~                           ~~~~~~~~~
     ROSE Softwareentwicklung                   ROSE Softwareentwicklung
     Dipl.-Ing. (FH) Ralph Roth                 Dipl.-Ing. (FH) Ralph Roth
     Finkenweg 24
     D 78658 Zimmern                            FAX:    +49.741-32647
     Germany                                    CET:    08.00 - 21.00!

Thank you for registering HackStop!  Origin: 1.14 Gamma3 (lb-27.10.96)