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TEXT_141.txt
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1996-10-30
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ツ Registration
Form
ツ
ツ
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.