*********************** CEREBRAL GAMING SYSTEMS Name________________________________________________________________________ Company_____________________________________________________________________ Address_____________________________________________________________________ City__________________ State______ ZIP_________ Country_____________________ Daytime Phone_________________________ Fax__________________________________ PRICE ITEM NUMBER DESCRIPTION QTY. EACH TOTAL ___________ ______________________________________ ____ _________ __________ ___________ ______________________________________ ____ _________ __________ ___________ ______________________________________ ____ _________ __________ ___________ ______________________________________ ____ _________ __________ ___________ ______________________________________ ____ _________ __________ ___________ ______________________________________ ____ _________ __________ ___________ ______________________________________ ____ _________ __________ ___________ ______________________________________ ____ _________ __________ A000-001 Battle Wrath Fan Club - 1 Year Memb. ____ $15.00 __________ Payment Method SUB-TOTAL ______________ [ ] Check or Money Order (U.S. Funds) [ ] VISA SHIPPING [ ] Mastercard ($1.00/Disk, $5.00 Max) ______________ Account Number___________________________ SALES TAX (N.C. Residents) ______________ Expiration Date__________________________ All disks are 3 1/2 inch 1.44 megabyte TOTAL ______________ Make checks payable to Cerebral Gaming Systems. U.S. funds only. No C.O.D.s accepted. Do not send cash. Int'l rates vary. Contact Cerebral prior to ordering. WHERE TO ORDER CEREBRAL GAMING SYSTEMS PRODUCTS: U.S. Mail: Cerebral Gaming Systems P.O. Box 10552 Raleigh, N.C. 27605 Attn: Ordering Fax: (919)-876-3098 Phone: (919)-850-9900 WWW: http://web.sunbelt.net/battlewrath