Registration 
Form

 

 

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 ________	AMEX ________	

Card Number:_____________________________________ 	Exp. Date: ______________	

Name on Card:	___________________________________________________________

Cardholder Signature (required):	______________________________________________

Please send my registration information via:  ___e-mail   ___fax  ___mail.