REGISTRATION INFORMATION ------------------------ Microflo Information Systems Pobox 73739 Lynwood Ridge Pretoria 0040 Rep of South Africa Fax : (012) 3421882 Ans serv (011) 6507083 Compuserve: Clarion Forum, 3rd Party Authors Section or EMAIL Charl/Andre - 100100,2557 CBWLib ORDER INFORMATION Ordered By : ____________________________________ (signature) Ordered By : ____________________________________ (printed name) Date : ____________ Licensee Information : Name : ___________________________________________ Address : ___________________________________________ Address : ___________________________________________ City,State,Zip : ___________________________________________ Voice Phone : ________________________ Fax : ________________________ One copy of CBWLib is needed for each site, networked computer, or programmer. Call for Site Licensing Prices. ----------------------------------------------------------------- # Description Price ----------------------------------------------------------------- 1071 CBWLib Run Time Libraries $89.00 __________ Excluding Post & Packaging ----------------------------------------------------------------- Payment by VISA ______ or MasterCard: ______ Card # : _____________________________ Expires : _____________________________ Name on Card (print) : __________________________________ Authorized Signature : __________________________________ -----------------------------------------------------------------