Prodecom 4.2b -- Individual User Registration Form
    Please register. By registering you will help in the development
    of Future release of Prodecom for Dos and Windows.

1. User information (please PRINT):

Name: ___________________________________________________________
Address: ________________________________________________________
City: ___________________ State/Province: _____________
Country :__________________________________ ZIP/PC: _____________
Phone number: (___)______________ Date (MM/DD/YY): ____/____/____
Email address: __________________________________________________

2. Shipping and Handling (check one):
   (Note: There is no disk charge if you use Email)

__ 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 Antoine Delle Donne. 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 Prodecom 4.2 or newer........... $29.00
__ US/Canada Shipping and Handling for computer disk .....  $5.00
__ Non US Shipping and Handling for computer disk ........ $12.00
__ Canadian residents add 7% Goods and Service tax........ $_____
__ Qu‚bec residents add 6.5% sales tax.................... $_____
Total:.....................................................$_____

4. Mail this form together with payment to:

   Antoine Delle Donne
   Prodecom Registration
   71a 2nd Avenue
   Ile Perrot, Qu‚bec
   Canada J7V 4Z3

   If credit card payment was selected, this form may be faxed to 
   514-453-1727 (Qu‚bec, Canada) or emailed to 25157@ican.net

Prodecom Home Page
http://www.geocities.com/WallStreet/1138/