Cobra Gunship Order Form Rev. 14NOV1997 ============================================================================= The unregistered version of Cobra Gunship lets you play only the first six missions. It also limits the equipment you can buy. Registering Cobra Gunship lets you play all 31 missions, load external missions, and buy all of the weapons. ============================================================================= ORDERING You may register the following ways: 1) Order on our web site (credit-card only) for a $1.00 discount: http://www.elys.com/ 2) Fill out this form and mail or fax it to us for a $0.50 discount. EMania c/o Agile Systems, Inc. P.O. Box 221 Raritan, NJ 08869-0221 (908) 369-1317 FAX 3) Place an order by telephone (credit-card only): (888) 369-0047 (U.S. only, 9am-5pm Eastern Time) or (908) 369-0084 (International, 9am-5pm US Eastern Time) ============================================================================= REGISTRATION AND DELIVERY INFORMATION We will issue you a serial number based upon the name you write below. It will be e-mailed to if you provide an e-mail address below. If you do not have an e-mail address or wish to receive a printed receipt, you may purchase a post card or FAX receipt. Name (as it appears on the credit card or check): _____________________________________________________________________________ Address (Credit Card address please): _______________________________________ _____________________________________________________________________________ City: _______________________________________________________________________ State/Province: ________________________ Zip/Postal Code: __________________ Country: ____________________________________________________________________ E-Mail Address (Internet style): ____________________________________________ Telephone Number: ___________________________________________________________ Fax Number: _________________________________________________________________ [ ] Please send me e-mail announcements about future Elysium Digital, L.L.C. products. (Your e-mail address will not be given out to anyone else.) ============================================================================= PRODUCT ORDER INFORMATION Cobra Gunship Registration w/ Discount.................... $21.00 $21.00 Discount for Postal Mail/Fax Ordering.....................-$ 0.50 -$ 0.50 -------- Discounted Price................................................... $20.50 You will be e-mailed your serial number. Additional delivery methods can be purchased: [ ] Post Card Receipt..................................... $ 1.00 ________ [ ] Fax-back (USA only)................................... $ 1.50 ________ ----------------------------------------------------------------------------- Subtotal........................................................... ________ New Jersey residents add 6% sales tax.............................. ________ ======== TOTAL: ________ ============================================================================= PAYMENT INFORMATION We're sorry, we cannot accept cash payment. Payment Method: [ ] Credit Card [ ] Check (postal mail orders only) ----------------------------------------------------------------------------- If you are paying by credit card, please complete the following: Indicate type of Credit Card: [ ] Visa [ ] Master Card [ ] American Express Credit Card Number: _________________________________________________________ Expiration Date: _________________________________________________________ Signature: _________________________________________________________