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| Registration of FaxMail for Windows and/or FaxMail for DOS, FAX-V133.ZIP |
|                                                                          |
|                            ElectraSoft                 1-713-261-0307    |
|                       3207 Carmel Valley Drive                           |
|                      MISSOURI CITY  TX  77459-3068                       |
|== Please Print ==========================================================|
|                                                                          |
| Date:____/____/____ Country:_______________ Wk Phone:___________________ |
|                                                                          |
| Name:______________________________________ Hm Phone:___________________ |
|                                                                          |
| Address:___________________________________ Fx Phone:___________________ |
|                                                                _         |
| City:________________________________ State:____ ZIP:___________________ |
|==========================================================================|
| Disk size: [ ]3.5-1.4MB  [ ]5.25-1.2MB  [ ]Other:_______________________ |
|-----+--------------------------------------------------------------------|
| Qty | Item                                                     Amount    |
|-----+--------------------------------------------------------------------|
|     |                                                                    |
|_____| FaxMail for Windows - - - - - - - - - - - - - - - $25.00 $_____.__ |
|     |                                                                    |
|_____| FaxMail for DOS - - - - - - - - - - - - - - - - - $25.00 $_____.__ |
|     |                                                                    |
|_____| 9 to 24 Pin Printer Translator  - - - - - - - - - $25.00 $_____.__ |
|     |                                                                    |
|_____| Snapshot Screen to Disk or printer  - - - - - - - $25.00 $_____.__ |
|                                                                          |
| Shipping and handling - - - - - - - - - - - - - - - - -  $4.00 $    4.00 |
|                                                                          |
| Subtotal  - - - - - - - - - - - - - - - - - - - - - - - - - -  $_____.__ |
|                                                                          |
| Texas residents please add Sales Tax (8%) - - - - - - - - - -  $_____.__ |
|                                                                          |
| Total (Pay this amount) - - - - - - - - - - - - - - - - - -  US$_____.__ |
|==========================================================================|
| Which Fax/Modem-Driver works best (found in your AUTOEXEC.BAT):          |
| [ ]FM_ROCK2.COM   [ ]FM_ROCK1.COM   [ ]FM_ATT1I.COM   [ ]FM_ATT2I.COM    |
| [ ]FM_PP1.COM     [ ]FM_CLS2I.COM   [ ]FM_CLS2E.COM   [ ]FM_DOVE1.COM    |
| [ ]FM_DALAS.COM   [ ]FM_ZOOM2.COM   [ ]FM_ZYXEL.COM   [ ]FM_CLAS1.COM    |
| [ ]CAS(none)                                                             |
| Fax/Modem Brand/Mod#:___________________________________________________ |
| Data Speed:  [ ]1200bps  [ ]2400bps  [ ]9600bps  [ ]14400bps [ ]16800bps |
|  [ ]16800bps [ ]19200bps [ ]28800bps [ ]38400bps [ ]Other:______bps      |
| FAX Speed:  [ ]1200bps  [ ]2400bps  [ ]9600bps  [ ]14400bps [ ]16800bps  |
|             [ ]19200bps [ ]28800bps [ ]38400bps [ ]Other:______bps       |
| Supported: [ ]HST  [ ]V.32  [ ]V.32bis  [ ]V.42bis  [ ]Other:___________ |
| Computer Brand:_________________________________________________________ |
| Processor:  [ ]8088  [ ]80286  [ ]80386  [ ]80486  [ ]Other:____________ |
| Machine Speed: [ ]25Mhz  [ ]33Mhz  [ ]50Mhz  [ ]66Mhz  [ ]Other:________ |
| Display Type: [ ]CGA  [ ]EGA  [ ]VGA  [ ]SVGA  [ ]Other:________________ |
| Floppy Drive(s): [ ]3.5, 1.4MB  [ ]5.25 1.2MB  [ ]Other:________________ |
| HardDrive Brand/Mod#:_______________________________ size:____________MB |
| Bugs or suggested improvements (print on back):_________________________ |
|                                                                          |
| Signature:__________________________________________ Date:______________ |
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