Gameport Secure Ordering Form

This form is for ordering by mail.
Please complete and print this form and send it together with a check to the address below:
MS Electronics - Gameport
10661 Rene St.
Lenexa, KS 66215

Product Description

Product:		SALE: T-Lord v1.26 for Worldgroup 3.x DOS - Unlimited User Version
Platform:		Galacticommaddons
Price:		US $199.00 includes for UPS shipping

BBS Information

BBS Name:
B BBS Registration Number:
BBS Dialup Number:
BBS Telnet Address:

Personal Information

First Name:
Middle Initial:
Last Name:
Street Address:
Apt/Suite #:
City:
State (U.S. only):
Province (Canada only):
Country:
Zip/Postal Code:
Work Phone:	US and Canada xxx-xxx-xxxx
Home Phone:	US and Canada xxx-xxx-xxxx
E-mail Address:

Register Software

Upon receipt of the amount of US $199.00, we will email you your activation code.

Details of this purchase and your activation code will be sent to you via E-mail as well.

Please make sure that your E-mail address is correct, otherwise your activation code will not reach you!

If, for some reason, you lose your activation code, please contact us and we will give it to you again.