Registration 
Form

 
Mail, fax, or e-mail form to: 

ELS, Inc.         
5200 NW 43rd Street, Ste 102-323                                                       
Gainesville, Florida 32606

Fax: (352) 375-5679
       Info: (352) 375-0558
     E-mail: elstech@elsinc.com

Register Online at our Web Site:   http://www.elsinc.com

Please register me for:

______ChatNet Personal Edition
..........................$25

______ChatNet 10 User License
..........................$99

______ChatNet 50 User License
........................$249

______ChatNet 250 User License
......................$499

Order Total:  $_____________
  (Florida residents add 6% sales tax)

User Name :______________________________________________________________

Address: ________________________________________________________________

City:
_________________________State: __________
  Zip:
_______________________

Country:_____________________ 
Daytime Phone: (_____
)
________________________

Fax Number: (____
)
______________ E-mail Address: _____________________________

Method of Payment:

_____Check or Money Order (US funds) enclosed payable to: ELS, Inc.

_____Charge my credit card:   MasterCard _______ 
VISA ________

Card Number:_____________________________________ 
Exp. Date: ______________

Name on Card:
___________________________________________________________

Cardholder Signature (required):
______________________________________________

Please send my registration information via:  ___e-mail   ___fax  ___mail.