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  1.  ========================= ORDER/REGISTRATION FORM ============================
  2.                Send this completed form and registration fees to:
  3.          POLYCOPY REGISTRATION - P.O. BOX 1126 - MARTINSVILLE, VA 24114
  4.  
  5.     Indicate method of payment (payable to NEOCOM Microspecialists, Inc.):
  6.     [ ] Check or Money Order (US Funds)
  7.     [ ] MastCard   [ ] VISA   Exp. Date __/__  Acct#: ________________________
  8.     Signature: ____________________________
  9.  
  10.      Credit card orders: 1-800-766-6861 or FAX 1-703-666-9534 (8am-5pm EST)
  11.    For information, or any other reason, call our voice line: 1-703-666-9534
  12.  ------------------------------------------------------------------------------
  13.   SINGLE COPY REGISTRATION
  14.   Disk with program and documentation:            $24.95 + Postage and handling
  15.  ------------------------------------------------------------------------------
  16.   SITE LICENSE (MULTI-COPY) REGISTRATION
  17.   Site license for the use of POLYCOPY.  (Includes single disk & multiple docs)
  18.  
  19.                      No. PCs                 Adjusted Price
  20.                   -------------------------------------------
  21.                       2 - 5                   $22.50 each
  22.                       6 - 19                  $18.75 each
  23.                      20 - 49                  $16.25 each
  24.                      50 - 99                  $13.75 each
  25.                     100 or more, $1,250 one time fee. (Call for details)
  26.  
  27.        NOTE:  With site licenses postage and handling are waved; however,
  28.               overseas order charges still apply.
  29.  ----------------------------------------------------------------------------
  30.  Price:                    $_____.__ x Qty = $_____.__
  31.  Shipping & Hand.:         $    2.50 x Qty = $_____.__ (Site licenses exempt)
  32.  Overseas or outside U.S.: $    5.00       = $____5.00 (if applicable)
  33.  
  34.                             Total enclosed:  $_____.__ (U.S. funds)
  35.  
  36.  Company: ___________________________   Your Name: __________________________
  37.  
  38.  Address: ___________________________________________________________________
  39.  
  40.  City: _________________________________      State: ___     Zip: ______-____
  41.  
  42.  Telephone: (    )___-____                  Version you already have: _______
  43.  
  44.  Preferred media (check one):            [ ] 3½ diskette      [ ] 5¼ diskette
  45.  Computer:     [ ] PC/XT or compatible   [ ] AT Class   [ ] 80386   [ ] 80486
  46.  EMM Driver:   [ ] HIMEM   [ ] QEMM386   [ ] 386MAX     [ ] Other ___________
  47.  
  48.  DOS or other operating system brand/version: _______________________________
  49.  
  50.  How and where did you find out about POLYCOPY?  ____________________________
  51.  
  52.  ____________________________________________________________________________
  53.  
  54.  Do you have any comments and/or suggestions?  ______________________________
  55.  
  56.  ____________________________________________________________________________
  57.