Registration / Order Form : U-Convert-It v1.20
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Ship To:                                    Date: ________________

Name: ____________________________________________________________

Company: _________________________________________________________

Address: _________________________________________________________

City, ST, Zip: ___________________________________________________

Phone or Fax: (optional) _________________________________________

Electronic Address: ______________________________________________

Where did you hear about U-Convert-It?____________________________

Downloaded from: _________________________________________________


To order send a CHECK or MONEY ORDER along with this form to:

	Fred Block
	P.O. Box 1533
	McAfee, New Jersey 07428

Disk Size Required:   [ ] 3.5" Disk   [ ] 5.25" Disk

Single-User Registration
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  1 - 3  [    ] copies @ $15.00 each = $ _______ 

Multiple-User Registration (Site License)
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 4 - 10  [    ] copies @ $12.50 each = $ _______
11 - 20  [    ] copies @ $10.00 each = $ _______
21 & UP  [    ] copies @ $ 8.00 each = $ _______

                      Total enclosed = $ _______

*All prices include one (1) original disk with each
 registration. Additional copies may be purchased for
 $2.00 each. For orders outside the continental U.S. or
 Canada, please add $4.00 shipping and handling.
 Payments must be in US dollars drawn on a US bank.

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