================== REGISTRATION FORM ================== If you want to register by telephone, fax, or check, use this form. To: Register Now! ATTN Orders PO Box 1816 Issaquah, WA 98027 United States of America Telephone Toll Free: 877-353-7297 Regular: 425-392-2294 Fax Toll Free: 888-353-7276 Regular: 425-392-0223 ORDER INFORMATION ================== Product Name : Hangman The Wild West II (ID 3488-6) Price : US$ 14.95 Quantity : Mail or fax orders, please add US$ 2.50 each order. Telephone orders, please add US$ 3.00 each order. Total : US$ PERSONAL INFORMATION ===================== First Name : Last Name : Company : Billing Address : City : State/Province : Zip/Postal Code : Country : Phone : *Email Address : PAYMENT INFORMATION ==================== [ ] Check (made payable to Register Now!) [ ] Visa [ ] MasterCard [ ] American Express [ ] Discover (Novus) Name on Card : Card Number : Expiration Date : * Email address is REQUIRED. We will send you the registration code via email.