Psycho Squares Order Form

[  ] YES!  I want to order the Registered Version of Psycho Squares.
I want to be able to play thirteen levels with my spouse and friends.
I want to have special privilages like access to the Dark Unicorn
Support Area on Blittering Heights BBS.  I understand that my name and
registration number will be imbedded into the game to deter me from
giving copies away to my friends and I am responsible for any copies
that get passed around.

I am enclosing $5.95 money order, cashier's check, or personal check 
(I realize that if I send you a personal check that it make take
forever for it to clear and you won't mail me the game until it 
does) to:

Shane Monroe  (Make checks payable to him, too.)
c/o Dark Unicorn Productions
1225 Boonhille Rd.  Suite K-5
Summerville, SC  29483

Mail all this good stuff to:

Name _______________________  Mr. Miss. Mrs. or Ms. (optional)

Address ____________________________________________ Apt. ____

City ________________________ State ____ Zip _________________

Evening Phone (optional) _____________________________________

Questionare (Optional)

Amiga Model Owned:  A1000  A500  A2000  A3000  A4000  A600  A1200

Primary Use:  Games  Video  Productivity  Programming  Other

Age of Primary User:  Under 18  18-25  25-35  35-45  45-65  65+

Peripherals owned (circle all that apply):
Hard Disk   Modem   Extra 3.5" Drive   Toaster   OpalVision
One Meg Fatter Agnus   Extra Fast Ram   Sysquest Drive

What other computers do you use?  _______________________________