LView Pro 1.B -- Individual User Registration Form 1. User information: Name: ___________________________________________________________ Address: ________________________________________________________ City: ___________________ State: _____________ ZIP: _____________ Country (if other than U.S.A.):__________________________________ Phone number: (___)______________ Date (MM/DD/YY): ____/____/____ E-mail address (optional): ______________________________________ 2. Choice of registered version (check one): __ 386 Windows 3.1, 16-bit application __ 386 Windows 3.1+Win32s/Windows NT, 32-bit application __ 486/Pentium Windows 3.1, 16-bit application __ 486/Pentium Windows 3.1+Win32s/Windows NT, 32-bit application 3. Shipping and Handling (check one): __ E-mail uuencoded file to: ____________________________________ __ 3.5'' DS/HD disk 4. Payment and fees: Fees are in U.S. dollars, please do not send cash. Checks and money orders must be made payable to MMedia Research. Select form of payment (check one): __ Enclosed check or money order in U.S. dollars __ Credit card payment: ___ VISA ___ MasterCard Card Number: ______________________________ Expiration Date (MM/YY): ____/____ Cardmember signature (required): ______________________________ Check all that apply and fill in the blanks: __ One registered copy of LView Pro 1.B or newer...........$30.00 __ U.S. Shipping and handling (if other than E-mail)........$5.00 __ Non U.S. Shipping and handling (if other than E-mail)...$12.00 __ Florida residents add appropriate sales tax.............$_____ Total:.....................................................$_____ 5. Mail this form together with payment to: MMedia Research Attn: Leonardo Haddad Loureiro 1501 East Hallandale Beach Boulevard, #254 Hallandale, FL 33009 USA Or: If credit card payment was selected, this form may be faxed to 305-458-9698 (Florida, U.S.A.) or E-mailed to mmedia@world.std.com.