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| Register of FaxMail for Windows and/or FaxMail for DOS, FAX-V144.ZIP |
|                                                                      |
|                            ElectraSoft                1-713-261-0307 |
|                       3207 Carmel Valley Drive                       |
|                      MISSOURI CITY  TX  77459-3068                   |
|== Please Print ======================================================|
|                                                                      |
| Date:____/____/____ Country:____________ Wk Phone:__________________ |
|                                                                      |
| Name:___________________________________ Hm Phone:__________________ |
|                                                                      |
| Address:________________________________ Fx Phone:__________________ |
|                                                             _        |
| City:______________________________ State:____ ZIP:_________________ |
|======================================================================|
| Disk size: [ ]3.5-1.4MB  [ ]5.25-1.2MB  [ ]Other:___________________ |
|-----+----------------------------------------------------------------|
| Qty | Item                                                 Amount    |
|-----+----------------------------------------------------------------|
|     |                                                                |
|_____| FaxMail for Windows - - - - - - - - - - - - - $25.00 $_____.__ |
|     |                                                                |
|_____| FaxMail for DOS - - - - - - - - - - - - - - - $25.00 $_____.__ |
|     |                                                                |
|_____| 9 to 24 Pin Printer Translator  - - - - - - - $25.00 $_____.__ |
|     |                                                                |
|_____| Snapshot Screen to Disk or printer  - - - - - $25.00 $_____.__ |
|                                                                      |
| Shipping and handling - - - - - - - - - - - - - - -  $4.00 $    4.00 |
|                                                                      |
| Subtotal  - - - - - - - - - - - - - - - - - - - - - - - -  $_____.__ |
|                                                                      |
| Texas residents please add Sales Tax (8%) - - - - - - - -  $_____.__ |
|                                                                      |
| Total (Pay this amount) - - - - - - - - - - - - - - - -  US$_____.__ |
|======================================================================|
| Which Fax/Modem-Driver works best (found in your AUTOEXEC.BAT):      |
| [ ]FM_ROCK2.COM  [ ]FM_ROCK1.COM  [ ]FM_ATT1I.COM  [ ]FM_ATT2I.COM   |
| [ ]FM_PP1.COM    [ ]FM_CLS2I.COM  [ ]FM_CLS2E.COM  [ ]FM_DOVE1.COM   |
| [ ]FM_DALAS.COM  [ ]FM_ZOOM2.COM  [ ]FM_ZYXEL.COM  [ ]FM_CLAS1.COM   |
| [ ]CAS(none)                                                         |
| Fax/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:___________ |
| Computer Brand:_____________________________________________________ |
| Processor: [ ]8088 [ ]80286 [ ]80386 [ ]80486 [ ]Other:_____________ |
| Machine Speed: [ ]25Mhz [ ]33Mhz [ ]50Mhz [ ]66Mhz [ ]Other:________ |
| Display Type: [ ]CGA [ ]EGA [ ]VGA [ ]SVGA [ ]Other:________________ |
| Floppy Drive(s): [ ]3.5, 1.4MB [ ]5.25 1.2MB [ ]Other:______________ |
| HardDrive Brand/Mod#:_____________________________ size:__________MB |
| Bugs or suggested improvements (print on back):_____________________ |
| ____________________________________________________________________ |
| Signature:________________________________________ Date:____________ |
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