Registration Form for WinConverter

Program-ID :

Last Name:
_______________________________________

First Name:
_______________________________________

Company:
_______________________________________

VAI-ID-No. (if applicable)
_______________________________________

Address:
_______________________________________

Postal Code and City:
_______________________________________

Country:
_______________________________________

Phone:
_______________________________________

Fax:
_______________________________________

E-Mail - Important information such as a license key for your software will be sent to you by email. Be advised that we do not accept email addresses from freemail-services like hotmail.com for credit card purchases:
_______________________________________

How would you like to pay the registration fee:

credit card - wire transfer - check - cash

Credit Card Information (if applicable)

Credit Cards: Visa - Eurocard/Mastercard - American Express - Diners Club

Card Holder: ________________________________

Card No.: ___________________________________

Expiration Date: ________

Date / Signature: ___________________________