LView Pro 1.D -- Individual User Registration Form
 
1. User information (please PRINT):
 
Name: ___________________________________________________________
Address: ________________________________________________________
City: ___________________ State: _____________ ZIP: _____________
Country (if other than USA): ____________________________________
Phone number: (___)______________ Date (MM/DD/YY): ____/____/____
Email address: __________________________________________________
 
2. Shipping and Handling (check one):
 
__ Email registration information to email address in (1) above.
__ Mail 3.5'' DS/HD disk to mailing address in (1) above.
 
3. Payment and fees:
Fees are in US dollars, please do not send cash. Checks and money 
orders must be made payable to MMedia Research. Select form of 
payment (check one):
 
__ Enclosed check or money order
__ Credit card payment: ___ VISA   ___ MasterCard
   Name on card: _____________________________
   Card Number: ______________________________
   Expiration Date (MM/DD/YY): ____/____/____
   Signature (required if form is faxed/mailed): _________________
 
Check all that apply and fill in the blanks:
 
__ One registered copy of LView Pro 1.D or newer.......... $30.00
__ US Shipping and Handling for computer disk ............  $5.00
__ Non US Shipping and Handling for computer disk ........ $12.00
__ Florida residents add appropriate sales tax............ $_____
Total:.....................................................$_____
 
4. Mail this form together with payment to: 
 
   MMedia Research Corp
   LView Pro Registration
   1501 East Hallandale Beach Boulevard, #254
   Hallandale, FL 33009
   USA

   If credit card payment was selected, this form may be faxed to 
   954-458-9698 (Florida, USA) or emailed to mmedia@world.std.com.