              COMPUPIC PURCHASE ORDER / REGISTRATION FORM
I would like a copy of CompuPic!  I understand that I will receive my own
personalized password with which to register the CompuPic software, and 
that by using CompuPic agree to all terms of the CompuPic licensing 
agreement. I also understand that CompuPic is protected by Federal 
Copyright Laws and International Treaty Provisions, and will not disclose 
my password to anyone.  If I operate a BBS or website, I understand that 
the CompuPic password is not in the public domain, and cannot be made 
available for download for users of my or any other BBS or website.  I 
understand that my correct phone number  is required for registration and 
will be kept strictly confidential.   Optional items marked with (*).

YOUR NAME:___________________________________ *Company:___________________
(PLEASE PRINT) First Name, Initial, Last name

Home Phone (_______) _______-________   *Work: (______) ______-___________

Addr:_____________________________________________________________________

City:_____________________________ State/Prov:_________ Zip:______________

How did you first discover CompuPic?______________________________________


                  

CompuPic Windows Registration(s)         ___   US $39.95  $____________
CompuPic Macintosh Registration(s)       ___   US $39.95  $____________
CD for CompuPic (optional, not required) ___   US $10.00  $____________
Advanced Batch Conversion Plug-In        ___   US $29.95  $____________
DataSAFE Encryption Plug-In              ___   US $29.95  $____________
Sales Tax (8.25 - TX Residents Only)                      $____________
                                             ORDER TOTAL  $____________

Credit Card Number:    __VISA __MasterCard __AMEX __Discover __CHECK ENCL.

________/________/________/________ Exp:____/____  Sign:X_________________

SEND ME THE CompuPic REGISTRATION PASSWORD VIA:

___ E-Mail (CompuServe, AOL, or Internet)..TO:____________________________

___ FAX.......FAX NUMBER (incl area code) ________________________________

___ US Mail (to above address)

Send Orders to Photodex Corporation:
   Internet/WWW:     http://www.photodex.com  (e-mail: sales@photodex.com)
   CompuServe:       e-mail: 74774,3570
   America On-Line:  e-mail: Photodex

Voice: 1-800-37-PHOTO or 1-512-406-3020 (8:30-5:30 CST)
Fax:   1-800-377-4676 or 1-512-452-6825
Mail:  Photodex Corporation                   * Sales terms and pricing
         1106 Clayton Lane, #200W             are subject to change
         Austin, Texas  78723                     without notice.

