E-Z Access Software Ltd. form1 5185 Hwy. 127, Bocebec 7/95 R.R. 2 St. Andrews, NB E0G 2X0 GST:# 899871750RT Order/Registration Form for Canadian Geographic Name: __________________________ Company: ______________________________ Address/Box: ______________________________ Apt:# _______________________ Street: _________________________________________________________________ City: _________________________________ Prov/State ______________________ Postal Code: ___________ Phone: _____-________-_________ Home [] Work [] Software will be shipped on a 3«" HD diskette unless otherwise specified. Disk size: 5¬LD 360kb [] 5¬HD [] 3«DD [] Check [x] the version you want. Canadian Funds [ ] For the period 1985 to the present v1.85 ----- $11.00 --> $ ________ [ ] For the period 1990 to the present v1.90 ----- $9.00 --> $ ________ Deduct 10% if a registered user of another E-Z Access Software product, which is? ____________________________________________ $ _______ (ONLY applicable when order is placed through E-Z Access Ltd.) For registered user only. If an update, what is the version # and last month indexed in your registered copy? v ____ M ____ Y _____ Updates are $6.95 -> $ ________ 7% GST on all Canadian orders: GST on: ($11.00 = 77›) ($9.00 = 63›) ($6.95 = 49›) --------> $ ________ 11% PST charged to New Brunswick orders: PST on: ($11.77 = $1.29) ($9.63 = $1.06) ($7.44 = 82›) PST -> $ ________ Shipping and Handling fee --------> $ 4.00 --------- Signature:______________________ Amt. Enclosed or charge to card $ _________ Check One: Visa[] - MasterCard[] #______________________ Expiry Date:___/___ Cardholder's Name as appears on Card: _____________________________________ print Please send check, money order or card information to above address. Did you sign the form for credit card authorization? Thanks.