LView Pro 1.D -- Site Registration Form
 
1. Company information (please PRINT):
 
Company Name: ___________________________________________________
Site Address:____________________________________________________
City: ___________________ State: _______________ ZIP: ___________
Country (if other than USA): ____________________________________
Phone number: (___)______________ Date (MM/DD/YY): ____/____/____
Authorized representative: ______________________________________
Email address:___________________________________________________
 
2. Shipping and Handling (check one):
 
__ Email registration information to email address in (1) above. 
__ Mail 3.5'' DS/HD disks to mailing address in (1) above
   (price within US: $5.00 per disk, outside US: $12.00 per disk)
 
3. Payment and fees:
 
Fees are in US dollars, please do not send cash. Checks and money 
orders must be made payable to MMedia Research. Select form of 
payment (check one):
 
__ Enclosed check or money order
__ Credit card payment: ___ VISA   ___ MasterCard    
   Name on card: _____________________________
   Card Number: ______________________________
   Expiration Date (MM/YY): _____/_____
   Signature (required if form is faxed/mailed): _________________
 
4. Pricing for the use of LView Pro 1.D or newer, per site computer 
   (Please write for pricing on quantities over 99 computers):
 
__  1st computer at $30:                               = $ 30.00
__  2nd to 24th computer at $20 each: ...... ____ x 20 = $______
__ Total US Shipping and Handling ...................... $______
__ Total Non US Shipping and Handling .................. $______
__ Florida companies add appropriate sales tax.......... $______
Total:.................................................. $______
 
5. Mail this form together with payment to:
 
   MMedia Research Corp
   LView Pro Registration
   1501 East Hallandale Beach Boulevard, #254
   Hallandale - FL - 33009
   USA
 
   If credit card payment was selected, this form may be faxed to 
   954-458-9698 (Florida, USA) or emailed to mmedia@world.std.com.