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Monkey Shines PC Registration

Mail this completed form with payment to:


Fantasoft, LLC
P.O. Box 14261
Madison, WI 53714-0261
USA
To order by phone, call us at (608) 222-8468.
To order by Fax call (608) 222-8468.
To order by E-Mail, send the information below to: Fantasoft1@aol.com

Last Name______________________________First___________
Address______________________________________________
_____________________________________________________
City_________________________State___________Zip_______
Country___________________Phone:______________________
E-Mail Address_________________________________________

I would like to register:


PC Version "Monkey Shines"...................____$20

Method of Payment:

*Total Due = $____

[ ] Cash - Check - Money Order


[ ] Visa - Mastercard - American Express - Discover
____________________________________________________
Account Number
Expiration Date
____________________________________________________
Name exactly as it appears on the credit card

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