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  1. REGISTRATION FORM SelfControl 2.0 e PPC
  2.  
  3. Dear User,
  4.  
  5. thank you very much for the use of SelfControl and your decision to honor the quality of this product.
  6. Please mail or e-mail this form completed to
  7.  
  8. Ulrich Hilger                                                                                CompuServe 100116,2751
  9. Avrillestrasse 5                                                                    Internet 100116.2751@COMPUSERVE.COM
  10. 65824 Schwalbach a. Ts.                                        
  11. Germany                                                                                            
  12.  
  13. Bank Account: Deutsche Bank Bad Homburg, Bank Code 50070010,
  14.               Account No. 3774478
  15. ------------------------------------------------------------------------------
  16. Yes, I would like to support shareware. Please add me to your list of loyal SelfControl users. With registration, I obtain the rights to receive upgrades at discounted rates and to receivce support directly from the author.
  17.  
  18. SelfControl Serial Number    __________________________________
  19.  
  20. Last Name                          ______________________________________________
  21.  
  22. First Name                ______________________________________________
  23.  
  24. Address                   ______________________________________________
  25.  
  26. City, State, ZIP _____________________________________________________
  27.  
  28. Country                            ______________________________________________
  29.  
  30. E-Mail                                                                                                        ________________________
  31. (CIS, AppleLink, etc.)
  32.                                                                                                                                 ________________________
  33.  
  34.                                                                                                                                 ________________________
  35. I found SelfControl
  36. through:             _________________________________________________
  37.  
  38.  
  39. Registration fee has been sent (please check one)
  40.  
  41. ___  cash included with                            ___  cash sent separately
  42.      this form                                                                     to above mentioned
  43.                                                                                             address of the author
  44.  
  45. ___  through international money order          ___ through international
  46.      to above mentioned address of                  bank transfer directly
  47.      the author                                     to the above mentioned
  48.                                                     bank account of the
  49.                                                     author