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  1.  
  2.                 =========================================
  3.                  ROBOCOMM 4.2  --  U.K. REGISTRATION FORM
  4.                 =========================================
  5.  
  6.                     Remit to:    NILDRAM SOFTWARE
  7.                                  82 Akeman Street
  8.                                  Tring, Herts
  9.                                  HP23 6AF
  10.  
  11.           Phone & Fax Orders:    0442 890303
  12.             U.K. Support BBS:    0494 431861
  13.  
  14.      ------------------------------------------------------------------
  15.      | Item                          | Quantity |  Price |    Total   |
  16.      |-------------------------------|----------|--------|------------|
  17.      | Robocomm version 4.2          | ________ | £25.00 | __________ |
  18.      |                               |          |        |            |
  19.      | Printed documentation         | ________ | £ 7.50 | __________ |
  20.      |                               |          |        |            |
  21.      | V.A.T                         |          | _____% | __________ |
  22.      |                               |          |        |            |
  23.      |---------------------------------------------------|------------|
  24.      |                                                   |            |
  25.      |   Total amount enclosed                           | __________ |
  26.      ------------------------------------------------------------------
  27.  
  28.      Check desired disk format:    ( ) 5.25" OK      ( ) 3.5" Required
  29.                   Disk density:    ( ) Low Required  ( ) High OK
  30.  
  31.      Payment by:  ( ) Cheque or postal order
  32.                   ( ) MasterCard
  33.                   ( ) Visa
  34.                   ( ) P.O. # _____________
  35.  
  36.      Card #: ____________________________________  Exp. Date: _________
  37.  
  38.  
  39.  Signature of card holder: ____________________________________________
  40.  
  41.  
  42.      Name:     ________________________________________________________
  43.  
  44.      Company:  ________________________________________________________
  45.  
  46.      Address:  ________________________________________________________
  47.  
  48.                ________________________________________________________
  49.  
  50.                ________________________________________________________
  51.  
  52.      Phone:    ________________________________________________________
  53.  
  54.