REGISTERATION FORM

                                  QMONITOR    


 Name: ______________________________________________

 Company: ___________________________________________

 Address: ___________________________________________

 City: ______________________________ State: ________

 Zip code: _____________________

 Phone: _____________________________  Ext: _________



 Product                          Quanity          Price/each       Total
------------------------------------------------------------------------------

 QMONITOR  (Server license)       _______      x       $75     =    _________  

 QSELECT   (Server license)       _______      x       $150    =    _________  

 MLOGOUT Server version
 WMLOGOUT Server Version          _______      x       $195    =    _________

 MLOGOUT/WMLOGOUT
 Special Offer for CIS users      _______      x       $150    =    _________

                                    


                                        ---------------------------------------

                        Shipping and Handling:     3.00/per item:   _________


                                         Tax (VA residents add %4): _________


                                         Total order:               _________

How do you wish to pay for your order:

       Purchase Order _______        Check _________        COD _____________

       Visa __________   Account Number:  ___________________________________
       Mastercard_____   Expiration Date: _________________



Please specify disk size:      5-1/4___________      3-1/2___________


Additional information:

        How did you learn of QMONITOR? ______________________

        What version Netware are you running? ______________

        Do you use Windows?                Yes           No


Please return form to:

        Dana Consultants
        PO Box 2953
        Reston, VA 22091

        (703) 620-3554