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sregistr.txt
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1995-10-15
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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.