  = WildEdit FAX Order Form =


SysOp/Program Name: _____________________________

WildCat Registration Number: ____-_________

BBS or Registration Name: __________________________________

(case sensitive - enter your BBS Name or your Name, this is the
 name by which the registration code will be keyed)


Address: _______________________________________

   City: _______________________________________

  State: __________________  ZIP: ______________

  Phone: __________________

  Email: _______________________________________


  I authorize CinCare/Ryan Andersen to charge my
 
  [ ] Visa/MasterCard   Card Number: _________________________

  [ ] American Express     Exp Date: ______________

   
  for ____ copies of WildEdit at $24.95 each for a
 
  total of $ ____________



  Signature: _______________________________________


  	 Fax to:
         ===========================================
         [  CinCare Software : 8976 Blue Ash Road  ]
         [         Cincinnati, OH 45242            ]
         [ Phone: 513-984-5900   Fax: 513-936-4022 ]
         [       Email: support@cincare.com        ]
         ===========================================