Order Form - Winspector v1.0 Registration 
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NAME/CONTACT____________________________________________________

COMPANY_________________________________________________________

STREET__________________________________________________________

CITY_____________________________________    STATE______________

COUNTRY_________________________    ZIP_________________________

TELEPHONE ______________________    FAX  _______________________

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License number                        US$40.00  x ___ = $_______ 
                                      Ship.&Handling    $ 4.00
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                                                Total:  $_______ 



Check   #: _____________________________________________________
Bank Name: _____________________________________________________


Signature: _____________________________________________________

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Mail this form and a check (U.S.A. Banks only please) payable to:

          Noriel chang Reissig
          Av. Republica do Libano, 434
          Pelotas - RS
          CEP 96055-710         Brazil 

E-Mail:   nchang@atlas.ucpel.tche.br

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