LView Pro 1.B -- Site Registration Form 1. Site information: Site Name: ______________________________________________________ Site Address:____________________________________________________ City: ___________________ State: _______________ ZIP: ___________ Country (if other than US): _____________________________________ Phone number: (___)______________ Date (MM/DD/YY): ____/____/____ Authorized representative: ______________________________________ E-mail address (optional):_______________________________________ 2. Choice of registered version(s) (check all that apply, up to the total number of copies being registered): __ 386 Windows 3.1, 16-bit application __ 386 Windows 3.1+Win32s/Windows NT, 32-bit application __ 486/Pentium Windows 3.1, 16-bit application __ 486/Pentium Windows 3.1+Win32s/Windows NT, 32-bit application 3. Shipping and Handling (check one): __ E-mail uuencoded file to: ____________________________________ __ 3.5'' DS/HD disks (Shipping and Handling: US: $5.00 per disk *, Non U.S.: $12.00 per disk *) * Each version checked in item (2) requires one separate disk. 4. Payment and fees: Fees are in U.S. 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 in U.S. dollars __ Credit card payment: ___ VISA ___ MasterCard Card Number: ______________________________ Expiration Date (MM/YY): ____/____ Cardmember signature (required): ______________________________ 5. Pricing for the use of LView Pro 1.B or newer, per site computer (Write for pricing on quantities over 99 computers): __ 1st computer at $30: ............................. = $ 30.00 __ 2nd to 24th computer at $20 each: ...... ____ x 20 = $______ __ 25th to 99th computer at $17 each: ...... ____ x 17 = $______ __ Total U.S. Shipping and handling (if not E-mail)..... $______ __ Total Non U.S. Shipping and handling (if not E-mail). $______ __ Florida companies add appropriate sales tax.......... $______ Total:.................................................. $______ 6. Mail this form together with payment to: MMedia Research Attn: Leonardo Haddad Loureiro 1501 East Hallandale Beach Boulevard, #254 Hallandale, FL 33009 USA Or: If credit card payment was selected, this form may be faxed to 305-458-9698 (Florida, U.S.A.) or E-mailed to mmedia@world.std.com.