Print & Complete this form and send to Address at bottom
Program
d'peg! - Version ______ (Located in Help > About menu of program) Price - $29.00
Your Name
email Address
Postal Address
Payment Method
[__] - Check / Money Order
Print Cardholder Name and Address on back if different from above
[__] - Credit Card
Card Number
Expiration Date
Phone
Signature
Survey Info (Optional)
Age - ___ Sex - ___ Occupation - ____________________
I learned of this program by :
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