Registration form

Registration form

Please fill in the form below completely, print it out, and FAX it to Regsoft.com (FAX number : 770-497-9234 ) or send it along with a cheque (please click here for details). If you choose to fill it out by hand, please print legibly.

I order:

Product      ID   # licenses:   unit price:   Total Price:

INF-Tool       7418   ________  x  $  59.00  =   $ _______ *)
(rebates for site licences)

Resource-Grabber   7453   ________  x  $  29.00  =   $ _______ *)
Resource-Gr./lifelg.   15626   ________  x  $  59.00  =   $ _______ *)

Phantastic Screens.   7454   ________  x  $   9.00  =   $ _______
Phantastic /lifelong   7455   ________  x  $  19.00  =   $ _______
Advertising Screens.   7456   ________  x  $  19.00  =   $ _______
Advertising/lifelong   7457   ________  x  $  29.00  =   $ _______ *)
Advertisement Packg.   7458   ________  x  $ 129.00  =   $ _______ *)

Total:               $ _______

*) $ 5.00 discount when registering by regular mail

Billing Information:

Email Address:   _____________________ @ ___________________________

	(important: your order may not be processed if this field is left blank)

Name: ___________________________________________________

	(as it appears on credit card)

Company name: ___________________________________________________

	(optional)

Address: ___________________________________________________

	(exactly as it appears on your statement; please include COUNTRY)

Phone Number: ___________________________________________________

Payment: [_] Check (mail this form along with a check in US Dollars to:

	Regsoft.com, 6595-G Roswell Road, Suite 732, Atlanta,
	GA 30328, USA.)

[_] Credit Card Number ____ ____ ____ ____

	[_] American Express [_] Visa [_] MasterCard [_] Discover (Novus)

      Expiration Date: ________________________

Where did you find the program? _________________________________________
      (which website or search engine or newsgroup or magazine or CDROM or person,.. -> thanks)

Date: _____________   Signature: _________________________

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