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REGISTER.DOC
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1992-08-13
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WinClaim Registration Form
In accordance with the Shareware concept, we ask that you register with
us if you use WinClaim beyond an initial trial evaluation period. You will
receive the latest update to the program and information about the WinEMC
Electronic Claims program (which is ONLY available to Registered Users).
Name:
Address:
City: State: Zip:
Phone:
Version: EXE Date:
System: Disk Type:
Printer:
Obtained From:
Name:
Address:
City: State: Zip:
Phone:
Registration is $95.00 by check, $90.00 if by Money Order, $85.00 if by
US Post Office Postal Money Order (only), or $80.00 cash. Please add $3.00
for shipping and handling. Make checks/money orders payable to Gary Boehm
and send to 2490 Fatima Place, Hamilton, OH 45013. Thank You!