-=-=-=-=-=-=-   LTI SafeGard Registration form  -=-=-=-=-=-=-=-=-=

Fill out the information below and forward to LTI      <R-A1>
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                Orders - 1-800-465-7047  (Credit card orders)

                Voice  - (905) 276-8835
                FAX    - (905) 897-7622

                EMail  -      (CIS) 74167,722
                         (INTERNET) Kwillows@Bix.Com
 
                Mail  -  LTI 
                         1188 Ostler Ct
                         Mississauga 
                         On Canada  
			 L5C 3G6	

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CUSTOMER INFORMATION:
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Last Name: _________________  First: ________________ Initial:___

Address: ________________________________________________________

City:_____________________________ Prov/State: __________________
   	           
Country: ________  ZIP / Postal Code: __________    date: _______        

EMail Address:___________________________________________________

Daytime Phone : ____________________  FAX : _____________________


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PRICING:  (All dollar values in US Dollars)
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INDIVIDUAL USE
  Latest Version of LTI SafeGard      .............. $39.95 _____

Site License (One full SafeGard package provided per site.) 

 2 to 9  computers .. at $31.95 each computers ___x $31.95  _____
10 to 49 computers .. at $22.95 each computers ___x $22.95  _____
50 or more .......... at $19.95 each computers ___x $19.95  _____

Extra program disk & documentation with purchase of
SITE LICENSE available at $10 each.	       ___x $10.00  _____

Shipping & Handling  $5 per order (US & CAN)                _____
                     $12 (International)

                                   Canadian orders add GST  _____
                                    Ontario orders add PST  _____

                                                Total     $ _____

Disk Size Required: ___  (3.5 inch disk is sent if not specified).
  								
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PAYMENT:
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VISA ___  MasterCard ___   Cheque___

Card Number ______________________________________________________

Expiry Date __________

Card Holder's Name _______________________________________________

TERMS:
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  VISA, Mastercard, Cheque, Money orders accepted.  
  Cheques and money orders should be made payable to LTI.
  Prices and terms subject to change without notice.
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				END