SciTech Display Doctor 5.3
          Order/Registration Form (Australian Customers Only)

    SciTech Software Australia                                   ___/___/___
    9 Mitchell St                                                                MM /DD /YY
    Richmond, 3121 AUSTRALIA
    Phone/Fax: (03) 9428-9810 / (03) 9428 9676

PLEASE PRINT OR TYPE CLEARLY!

    Name: ______________________________________________________________

    Company: ___________________________________________________________

    Address: ___________________________________________________________

             _________________________________________ City ____________ 

             State __________ Post Code________ Country ________________

    Phone: _______________________________  Fax: _______________________

    Email: _____________________________________________________________

    Register product(s) to: [ ] Company     [ ] Individual

    Pay By:   [ ] Cheque  [ ] Money Order  [ ] Credit Card
               *$10.00 charge for all returned cheques
    Credit Card Orders: MasterCard / Visa / Bankcard (Circle one)

        Card Number ___________________________________ Expires ___/___

        Exact name on card (print) ____________________________________

     Price List                                 Cost        Qty   Price
     ------------------ ------------------      -----       ---   ------
     Display Doctor 5.3                         A$44.95*    ___ $ ______
     Disk & Manual                              A$15        ___ $ ______

   *Includes any 5.x upgrades (available online)

     Subtotal:                                                  $ ______
     Freight Charges (See below for amount!):                   $ ______
     Total Enclosed:                                            $ ______

  I have read and agree to abide by the enclosed license agreement and I 
  agree to be bound by my credit card agreement.

      (Signature required) _____________________________________

SHIPPING CHARGES: If a disk & manual are ordered the freight charge is A$6.
  Orders without disk & manual will receive a receipt and registration code
  via postal mail for no additional charge.