Wild Checklist
Order / Registration Form



Last name: ___________________________________

First name: ____________________________________

Company: ____________________________________

Street and #: ______________________________________

City, State, postal code: ________________________________

Country: _______________________________________

Phone: _____________________________________

Fax: ________________________________________

E-Mail: ______________________________________

*** Please do not forget to include your e-mail address. ***
*** We will use e-mail to communicate with you. ***

Product	Quantity (# of users)		Price (per user)		Tax (IL 6.5%)		Total
Wild Checklist v1.1 - Standard Edition (Single User)	________	X	$12.95 US	+	________	=	________
Wild Checklist v1.1 - Professional Edition (Single User)	________	X	$22.95 US	+	________	=	________
Wild Checklist v1.1 - Professional Edition Upgrade from Standard Edition ORIGINAL ORDER CONFIRMATION# ________________________ (or key code)	________	X	$10.00 US	+	________	=	________

*** Illinois residents must add sales tax.

Please make your check or money order payable to: Software Maniacs, Inc. and mail to:

Software Maniacs, Inc. P.O. Box 1121 Woodstock, IL 60098