Ship to:
========

Name:   _________________________________________________

Address:_________________________________________________

        _________________________________________________

City:   ___________________  Province/State: ____________

Postal Code/Zip:_____________  Country: _________________



Optional Information: 
=====================

Phone:  _______________________  Fax: __________________

E-Mail: ________________________________________________



Pay To:
=======
		Infomate Inc.
		1216 Whiterock St., Ottawa
		ON. K1J 1A7, Canada
		
		Attn. QuickSearch

Enclosed is a [ ] Check       for  [ ] US$10.00  /user
              [ ] Money Order      [ ] CAN$12.00 /user
                                   [ ] US$50.00 /10 users
				   [ ] CAN$60.00 /10 users



How did you hear about QuichSearch? 

____________________________________


Comments & Suggestions:
=======================