US order-form/registration astro-world for windows version 2.1

Sender Name:___________________________________________________
Address _______________________________________________________
_______________________________________________________________
_______________________________________________________________
Telephone #:___________________________________________________

I obtained Astroworld from: ___________________________________
 
I would like to order on 3 1/2" HD-Diskettes: 
(  )  Unregistered Trial-Version 2.1              US$   5
(  )  Update from 2.0 to 2.1                      US$  15
(  )  Registration of the Version 2.1             US$  65
(  )  Registration of Professional Version        US$ 160
(  )  Registration of Extended Astro font*        US$  12.50
(  )  Registration of Metaphysical reference
       file (Esoteric Encyclopedia for Windows)   US$  12.50
       
*** Postage and handling (per order)	          US$  5  ***

US denomination preferred, otherwise add: $10 clearing fee for non-dollar checks.

      * not included in the program, contains asteroids, zodiacal pictograms, etc.

I would like to order following additional Databases of places, each costing US$ 15. 
Number of places in parantheses. Available only for registered users:

(  )  #001:   Germany, Austria, Switzerland, FL (7400)
(  )  #002:   France, Benelux (6200)
(  )  #003:   UK, Ireland, Scandinavia (8300)
(  )  #004:   PL, CSFR, H, BG, R, YU, ALB, Estl., Lit. GR, TK (5800)
(  )  #005:   Italy, Spain, Portugal, Andorra, Malta (6000)
(  )  #006:   former. UdSSR, without the Baltic  (12000)
(  )  #007:   Africa (11000)
(  )  #008:   Asia without Mainland China, India and Japan (5600)
(  )  #009:   Central- and South-America (10000)
(  )  #010:   China (9700)
(  )  #011:   Australia, New-Zealand, Pacifik (4800)
(  )  #012:   India, Japan (6000)
(  )  #013:   Canada (3200)

(  )  #021:   USA: AL, AK, AZ, AR, CO (13000)
(  )  #022:   USA: CA, CT, DE, DC, FL (12000)
(  )  #023:   USA: GA, HI, ID, IL (11000)
(  )  #024:   USA: IN, IA, KY (11000)
(  )  #025:   USA: KS, LA, ME, MD (11000)
(  )  #026:   USA: MA, MI, MN, MS (12000)
(  )  #027:   USA: MO, MT, NE, NV, NH, NM (10000)
(  )  #028:   USA: NJ, NY (10000)
(  )  #029:   USA: NC, ND, OH (11000)
(  )  #030:   USA: PA (10500)
(  )  #031:   USA: OK, OR, PR, RI, SC, SD (9700)
(  )  #032:   USA: TN, UT, VT, WI, WY (10800)
(  )  #033:   USA: TX, WA (9500)
(  )  #034:   USA: VA, WV (10600)

Within the USA and Canada send a check (or Money Order for fast processing) and 
please add US$ 5.00 for shipping and handling per order ($10.00 for overseas).

The amount of $_______________________  payable to Kenneth Hirst
(Please send to: Kenneth Hirst, P.O. Box 5362, Irvine, CA 92716)

Date & Signature: ___________________________________________________
