E-Z Access Software Ltd. Form2 P.O. 395 7/95 Calais, ME 04619-0395 GST: 899971750RT Registration/Order Form For EZ-Index for National Geographic. Use this form for "ALL" Credit Card orders placed through E-Z Access Software Ltd. and all Canadian money orders and checks. Name: __________________________ Company: _______________________________ Address: ____________________________________ Apt:# ______________________ M D Y Street: ________________________________ Ctry.__________ Date:___/___/____ City: ________________________________ State/Prov: ______________________ Zip/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 [] (Please check one [x] ) CAN. funds [ ] For the period Jan/1960 to the present ---- v1.60 - $19.95 = $ [ ] For the period Jan/1965 to the present ---- v1.65 - $18.50 = $ [ ] For the period Jan/1970 to the present ---- v1.70 - $17.00 = $ [ ] For the period Jan/1975 to the present ---- v1.75 - $15.75 = $ [ ] For the period Jan/1980 to the present ---- v1.80 - $14.50 = $ [ ] For the period Jan/1985 to the present ---- v1.85 - $13.00 = $ [ ] For the period Jan/1990 to the present ---- v1.90 - $10.65 = $ ________ EZ-Index v1.50 covers the period of Jan/50 to Dec/59 [ ] If EZ-Index v1.6X5 (includes EZ-Index v1.50) - $26.95 --> $ ________ [(v1.50) $7.00 + (v1.60) $14.95 = $26.95 + S/H] If ordered separatly use $8.00 [ ] EZ-Index v1.50 Jan/1950 to Dec/1959 - $ 8.00 ---------> $ ________ (only available to registered user of EZ-Index v1.60) Deduct 10% if a registered user of another E-Z Access Software product. Other product? ______________________________________ $ ________ (ONLY applicable when order is placed through E-Z Access Ltd.) Registered Users Only: If an update what is the version # and last month indexed in your registered copy? v ____ M ____ Y ____ Updates are $9.25 --> $ ________ Shipping and Handling -----> $ 4.00 --------- Add 7% GST to all Canadian orders (addresses): ------> $ _________ Add 11% PST to all New Brunswick orders (addresses): -------> $ ________ Signature:______________________ Total Enclosed or charge to card $ ________ Check One: Visa[] - MasterCard[] #_______________________ Expiry Date:___/___ Cardholder's Name as appears on Bank Card: _________________________________ (print) In Canada send this form to: E-Z Access Software Ltd. 5185 Hwy. 127, R.R. 2 Saint Andrews, NB. E0G 2X0