Anonymity 4 Proxy ver. 1.52 (Product ID# 15209):  order form
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Mail this form to:	RegSoft.com, Inc.
                        PMB201
                        10820 Abbotts Bridge Road
                        Suite 220
                        Duluth, GA 30097
                        USA   

Or fax it to:		770-497-9234
			

Or just call:		1-877-REGSOFT (U.S. customers)
			770-319-2718  (other countries)


Check, money order or credit card order accepted
---------------------------------------------------------------------
Note: for mailed orders, the checks need to be in US Dollars and made
out to "Regsoft.com Inc".

A purchase order must be faxed or mailed to the address listed above
with all necessary information including billing information.


Order Information
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Anonymity 4 Proxy (Product ID# 15209)      Price/Unit   Q-ty     Total
----------------------------------------------------------------------
License for a server 
and two client computers                       $35.00   ____   _______


TOTAL AMOUNT (US Dollars) 		      	    	       _______


Payment Information
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
First Name:      _____________________________________________________

Last Name:       _____________________________________________________

Company:         _____________________________________________________

Street Address:  _____________________________________________________

                 _____________________________________________________

City: 		 _____________________________________________________

State/Province:  _____________________________________________________

Zip/Postal Code: _____________________________________________________

Country:         _____________________________________________________

Daytime Phone:   _____________________________________________________

Fax:             _____________________________________________________

Email Address:   _____________________________________________________

Payment:         __ MasterCard     __ VISA     __ AMEX     __ Discover
                 __ Check       __ Money order       __ Purchase order


For credit card orders:

Name on Card: ________________________________________________________

Credit Card Number: __________________________________________________  

Expiration Date: month _______________ year (4 digits) _______________


                Signature : ____________________  Date: ______________