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                        WHDLoad Registration Form

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                Please fill out this form properly and
                send it together with your payment to:

                        Bert Jahn
                        Franz Liszt Strasse 16
                        Rudolstadt
                        07407
                        GERMANY

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    EMail
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    Name
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    Street
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    ZIP / Town
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    Country
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                                     _
    I want receive my keyfile via:  |_| email             20 US$ / 30 DM
                                     _
                                    |_| mail              23 US$ / 35 DM

    You may also send cash in your local currency, you have to calculate
    the amount yourself by using the actual exchange rate and adding 10%
    to cover bank currency conversion commission.
                                     _
    available only inside Germany:  |_| per Nachnahme              43 DM

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      I have read the Licence and the Disclaimer and agree with them.


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