FeeCalc for Windows v1.2
                           Registration form
               (see README.TXT or help file for details)


Please include the following information:		 ___________
                                                         Date

__________________________________________________
Name

____________________________________________________________________
Practice Name (as it will appear in registered version)

_________________________________	 ___________________________
Street					 City	  State/Pr  Zip Code

_____________    __________________      ______________________
Country          Phone                   Fax (optional)

____________________________________________________________________
E-mail address(-es) (optional)

____________________________________________________________________
Where did you find FeeCalc? (optional)

====================================================================
					     Qty     Price     Total
====================================================================

FeeCalc for Windows v1.2 Registration	     ___  x  $25.00  $______

Extra 3.5" Distribution Diskettes            ___  x   $5.00  $______

Extra 5.25" Distribution Diskettes           ___  x   $5.00  $______


			 GRAND TOTAL:			     $______

====================================================================
Mail your completed registration form to:

         Terry Bond
         Information Consulting
         115 Ridgeview Dr.
         Athens, GA 30606-3857
         USA

Thank you for supporting the shareware concept and encouraging the
future development of FeeCalc!