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*                                                                              *
*                          CHAMPROGRAMMING ORDER FORM                          *
*                                                                              *
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1. NAME AND ADDRESS:                       3. CLASSIC GAMES WISH LIST:

______________________________________         1. ____________________________

______________________________________         2. ____________________________

______________________________________         3. ____________________________

Phone: (______)____________ Age: _____         4. ____________________________

Email: _____________@_________________         5. ____________________________

2. HARDWARE PROFILE:                       4.  HOW WERE YOU INTRODUCED TO
   (Describe your computer system)             CHAMPROGRAMMING?

Processor (386/486/Pentium): _________         _______________________________

      Do you use a joystick? _________     5.  WHAT DO YOU LIKE MOST ABOUT
																							 CHAMP GAMES?
   Do you have a sound card? _________

6. ORDER INFORMATION:

 Quantity  Item Code         Item Description            Unit Price Total Price
--------------------------------------------------------------------------------
|        |   CG05    |   CHAMP KONG                     |  17.95   |           |
|________|___________|__________________________________|__________|___________|
|        |   CG04    |   CHAMP MS. PAC-EM               |  14.95   |           |
|________|___________|__________________________________|__________|___________|
|        |   CG03    |   CHAMP ASTERIODS  (6/96)        |  17.95   |           |
|________|___________|__________________________________|__________|___________|
|        |   CG01    |   CHAMP PAC-EM     (5/96)        |  12.95   |           |
|________|___________|__________________________________|__________|___________|
|        |   CG02    |   CHAMP CENTIPEDE  (5/96)        |  12.95   |           |
|________|___________|__________________________________|__________|___________|
|        |   CG99    |   CHAMP CABLE                    |  17.95   |           |
|________|___________|__________________________________|__________|___________|
   ********************************                                |           |
   *    SATISFACTION GUARANTEED   *                      Subtotal: |___________|
   *                              *                                |           |
   * If, for any reason, you are  *     (CT Residents add 6%) Tax: |___________|
   *   not satisfied, write our   *                                |           |
   * Customer Service Department  *                      Shipping: |___________|
   ********************************                                |           |
                                                  - CHAMP Coupons: |___________|
                                                                   |           |
   Shipping and Handling:                                   Total: |___________|
    -> $2 for first item + $1 for each additional item.
    -> All merchandise will be shipped within 2-4 weeks of purchase!

    Send to: CHAMProgramming Inc.
             34-3 Shunpike Road,
             Cromwell, CT 06416                        THANK YOU FOR YOUR ORDER!
