BAD TOYS  REGISTRATION FORM
                ----------------------------------------
 // This information is REQUIRED in order to process your registration //

                                            Date (dd/mm/yy)  ___/___/___

          Name: ________________________________________________________

       Address: ________________________________________________________

          City: ________________________________________________________

State/Province: ________________________________________________________

   Zip/Country: ________________________________________________________

      Payment
      -------

  [ ] Amount paid by cheque (takes up to 10 days to clear)

  [ ] Money Order (please use mailing address shown below)

  [ ] Transfer to our bank account (please use bank info shown below)

  [ ] Credit Card   (only EuroCard/MasterCard)

      Card Number : ________ ________ ________ ________

      Expires     : ___/___

      Exact name on card (print) : ________________________________

            Signature(REQUIERED) : ________________________________


  SUBTOTAL                                       $21.00
  Shipping                                       $04.00
                                               -----------
  TOTAL AMOUNT                                   $25.00

  Signature(REQUIERED) : ________________________________

  Our mailing address:                Our bank Account:
  --------------------                -----------------
  Valach Pavel                        Ceskoslovenska Obchodni Banka A.S.
  Varsavska 238                       pobocka Pardubice
  53009 Pardubice                     Masarykovo nam. 1458
  Czech Republic                      account number 20541010