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iregistr.txt
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1996-04-26
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LView Pro 1.D -- Individual User Registration Form
1. User information (please PRINT):
Name: ___________________________________________________________
Address: ________________________________________________________
City: ___________________ State: _____________ ZIP: _____________
Country (if other than USA): ____________________________________
Phone number: (___)______________ Date (MM/DD/YY): ____/____/____
Email address: __________________________________________________
2. Shipping and Handling (check one):
__ Email registration information to email address in (1) above.
__ Mail 3.5'' DS/HD disk to mailing address in (1) above.
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/DD/YY): ____/____/____
Signature (required if form is faxed/mailed): _________________
Check all that apply and fill in the blanks:
__ One registered copy of LView Pro 1.D or newer.......... $30.00
__ US Shipping and Handling for computer disk ............ $5.00
__ Non US Shipping and Handling for computer disk ........ $12.00
__ Florida residents add appropriate sales tax............ $_____
Total:.....................................................$_____
4. 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.