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 | Registration of FaxMail for Windows and/or FaxMail for DOS, FAX-V124.ZIP |
 |                                                                          |
 |                            ElectraSoft                 1-713-261-0307    |
 |                       3207 Carmel Valley Drive                           |
 |                      MISSOURI CITY  TX  77459-3068                       |
 |== Please Print ==========================================================|
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 | Date:____/____/____ Country:_______________ Wk Phone:___________________ |
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 | Name:______________________________________ Hm Phone:___________________ |
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 | Address:___________________________________ Fx Phone:___________________ |
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 | City:________________________________ State:____ ZIP:___________________ |
 |==========================================================================|
 | Disk size (Please check one): []5.25  []3.5                              |
 |-----+--------------------------------------------------------------------|
 | Qty | Item                                                     Amount    |
 |-----+--------------------------------------------------------------------|
 |     |                                                                    |
 |_____| FaxMail for Windows - - - - - - - - - - - - - -  $25.00  $_____.__ |
 |     |                                                                    |
 |_____| FaxMail for DOS - - - - - - - - - - - - - - - -  $25.00  $_____.__ |
 |     |                                                                    |
 |_____| Both FaxMail for DOS and Windows  - - - - - - -  $45.00  $_____.__ |
 |                                                                          |
 | Shipping and handling - - - - - - - - - - - - - - - -   $4.00  $    4.00 |
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 | Subtotal  - - - - - - - - - - - - - - - - - - - - - - - - - -  $_____.__ |
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 | Texas residents please add Sales Tax (8%) - - - - - - - - - -  $_____.__ |
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 | Total (Pay this amount) - - - - - - - - - - - - - - - - - -  US$_____.__ |
 |==========================================================================|
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 | Bugs or suggested improvements (print on back side if needed):__________ |
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 | ________________________________________________________________________ |
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 | Computer Brand:_________________________________________________________ |
 | Processor: []8088  []80286  []80386  []80486  []Other:__________________ |
 | Machine Speed: []25Mhz  []33Mhz  []50Mhz  []66Mhz  []Other:_____________ |
 | Display Type: []MDA  []HGC  []CGA  []MCGA  []EGA  []VGA  []SVGA          |
 |               []Other:_______________                                    |
 | Floppy Drive(s): []3 1/2" 1.4MB  []5 1/4" 1.2MB  []Other:_______________ |
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 | HardDrive Brand/Mod#:_______________________________ size:____________MB |
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 | Modem Brand/Mod#:_______________________________________________________ |
 | Data Speed: []1200bps  []2400bps   []9600bps  []14400bps  []16800bps     |
 | []16800bps  []19200bps []28800bps  []38400bps []Other:______bps          |
 | FAX Speed:  []1200bps  []2400bps   []9600bps  []14400bps  []16800bps     |
 | []19200bps  []28800bps []38400bps  []Other:______bps                     |
 | Supported:  []HST  []V.32  []V.32bis  []V.42bis  []Other:________________|
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 | Signature:__________________________________________ Date:______________ |
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