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  1.                EPS Fixer Registration Form
  2.  
  3. Name:   __________________________________________________
  4.  
  5. Mailing Address: _________________________________________
  6.  
  7.       ____________________________________________________
  8.  
  9.       ____________________________________________________
  10.  
  11. Country:    ______________________________________________
  12.  
  13. EMAIL:  __________________________________________________
  14.  
  15. Where you got this software:    __________________________
  16.  
  17.       ____________________________________________________
  18.  
  19.  
  20. Fees:       Single Machine License:                 $10.00
  21. Additional Licenses: (__ @$7.00 each)              _______ 
  22. Georgia Residents add 6% sales tax                 _______ 
  23. Total Amount Due:                                  _______
  24.  
  25. Fees may be paid by cash, check, or money order payable in 
  26. U.S. currency. Checks must be drawn on a U.S. bank in U.S. 
  27. dollars.
  28.  
  29. Suggestions/Comments:   __________________________________
  30.       ____________________________________________________
  31.       ____________________________________________________
  32.       ____________________________________________________
  33.       ____________________________________________________
  34.       ____________________________________________________ 
  35. Send this form to: 
  36.     David Schooley 
  37.     200 26th St. NW. Apt N-203 
  38.     Atlanta, GA 30309
  39.     USA
  40.