Private Music Collection Registration Form

NOTE: THIS IS THE REGISTRATION FORM FOR VERSION 1.21 IF THERE IS
A NEWER VERSION IT WILL BE SENT TO YOU TOGETHER WITH YOUR KEY.

Site licenses:  A site license for PMC entitles an organization
to receive one copy of the distribution package and to duplicate
the distribution disk for the specified number of copies.

PMC ____    copies at $25 / HFl 30 / DM 30 each = ___________
The latest version on disk $10 / HFl 10 / DM 10    = ___________

I pay

[ ] cash
[ ] International cheque (costs $5 extra to process) ___________
[ ] Eurocheque
[ ] to  Bankaccount 33.12.67.381 Rabobank Kampen (NL only)

Tatal Costs					=___________

Name: ________________________________________________________________

Company: _____________________________________________________________

Address: ______________________________________________________________

City, State, Zip: _________________________________________________________

Country: _______________________________________________________________

Electronic Mail address: _________________________________________________

I agree that I get a temporary key for the first 21 days. During that period I can get my money back.
I agree that once I've got my personal key I can do no backorders anymore.
I understand that my order and payment won't be processed and nor returned when my order or payment is improper.

Date:______________	Sign:_____________________________________________