              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, 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.  I understand that my correct phone number is
required for registration and will be kept strictly confidential.
Optional items marked with asterisk (*).

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

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

Addr:_____________________________________________________________________

City:_____________________________ State/Prov:_________ Zip:______________

How did you first discover CompuPic?__________________________________________

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                                                -QTY-  --PRICE--    --TOTAL--
CompuPic Windows Registration(s)                ___   US $39.95  $____________
CompuPic Macintosh Registration(s)              ___   US $49.95  $____________
3.5 Disk (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  $____________
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Credit Card Number:    __VISA __MasterCard __AMEX __Discover __CHECK ENCL.

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

SEND ME THE COMPUPIC REGISTRATION PASSWORD VIA:

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

