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  1.     +--------------------------------------------------------------------+
  2.     |                                                                    |
  3.     |  I wish to license _____ copy/copies of PCX2EXE.                   |
  4.     |                                                                    |
  5.     |  I have version _____.                                             |
  6.     |                                                                    |
  7.     |  Number of copies:                                                 |
  8.     |                                                                    |
  9.     |  Single User      _____ at £12/$20                                 |
  10.     |                                                                    |
  11.     |  Corporate User   _____ at £25/$40                                 |
  12.     |                                                                    |
  13.     |  Name ___________________________________________________________  |
  14.     |                                                                    |
  15.     |  Company (if applicable) ________________________________________  |
  16.     |                                                                    |
  17.     |  Address ________________________________________________________  |
  18.     |                                                                    |
  19.     |  Town/City ______________________________________________________  |
  20.     |                                                                    |
  21.     |  County/ State ______________________  Post/Zip Code ____________  |
  22.     |                                                                    |
  23.     |                                                                    |
  24.     |  Please Send:  _____ 3.5" disk(s);  _____ 5.25" disk(s)            |
  25.     |                                                                    |
  26.     +--------------------------------------------------------------------+
  27.  
  28.  
  29. Please send the form, with your remittance, to :-
  30.  
  31.      Mike Williams
  32.      36 Laithwaite Close
  33.      LEICESTER LE4 1BX
  34.      England
  35.