Softronics MultiMedia Logic V1.0 Order Form

License type		[ ] Personal License $34.95 US
			[ ] Site License     $99.95 US

			Full Name (min 4 chars):

			Personal license must be a personal name.

			Site license must be an organization name.
			Site licenses do not cover entire school
			systems or schools within a town.

                        Price includes updates (1.1, 1.2 etc.).
			Price includes taxes, S+H (for US only).
			Prices subject to change without notice.

Pay for it by		[ ] Cash US (least preferred)
			[ ] Personal or Bank Check (US Bank only)
			[ ] Charge Card
				[ ] Master Card
				[ ] Visa
				[ ] Discover
				[ ] American Express
				Card Number:
				Expiration Date:
				Name on Card:
				Signature: _______________________
				Address:

Send your password by	[ ] Fax
				Fax #:
			[ ] Email
				Electronic Address:
			[ ] Postal Mail (no media will be sent)
				Name:
				Address:

Send this form by	[ ] Fax (no cover pages needed)
				Fax #: (508) 393-0854
			[ ] Postal Mail
				Softronics, Inc.
				33 Thoreau Road
				Northboro MA 01532
				USA

Obtain Media by		[ ] WWW
				http://www.softronix.com