home *** CD-ROM | disk | FTP | other *** search
- LView Pro 1.D2 -- Site Registration Form
-
- 1. Site information (please PRINT):
-
- Site Name: ________________________________________________________
- Authorized representative: ________________________________________
- Address line 1:____________________________________________________
- Address line 2:____________________________________________________
- City: _____________________ State: _______________ ZIP: ___________
- Country (if other than USA): ______________________________________
- Phone number: (____)_______________ Date (MM/DD/YY): ____/____/____
- Email address:_____________________________________________________
-
- 2. 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 ( )AMEX ( )Discover
- Name on card: _____________________________
- Card Number: ______________________________
- Expiration Date (MM/YY): _____/_____
- Signature (required if form is faxed/mailed): _________________
-
- 3.1 Pricing for the use of LView Pro 1.D2 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 = $______
- 25th to 99th computer at $17 each................____ x 17 = $______
- Total licensing............................................= $______
-
- 3.2 Shipping and Handling
-
- Email delivery of site name and ID is free worldwide.......= $ 0.00
- CD-ROMs shipped WITHIN USA at $10.00 each........____ x 10 = $______
- CD-ROMs shipped OUTSIDE USA at $18.00 each.......____ x 18 = $______
- 1.44 disks shipped WITHIN USA at $5.00 each......____ x 5 = $______
- 1.44 disks shipped OUTSIDE USA at $12.00 each... ____ x 12 = $______
- Total shipping and handling................................= $______
-
- 3.3 Totals
-
- Add total licensing (3.1) + total S&H (3.2)................. $______
- Florida sites please add appropriate sales tax...............$______
- Grand 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 register@lview.com
-