GoMac 1.4.4 Registration Form             Send  Proteron
                                          with  Attn: GoMac Sales
                                       payment  9600 East 150 Highway
                                            to: Kansas City, MO 64149

 ...or register on the internet at <http://www.proteron.com/gomac>.

====================== Registration Information ======================

   <LastName>, <FirstName> <MI>
   <Company>
   <Address1>
   <Address2>
   <City>, <State> <Zip>
   <Country>

   *EMail: <EMail>

------------------------ Purchase Information ------------------------

   Purchase Quantity: <Copies> copies

     <Copies1995> at $19.95

     <Copies0500> at  $5.00

   Bulk Purchase Price:

     <Copies1495> at $14.95


   Total cost: <Total>

------------------------ Payment Information -------------------------

   **Payment Method: <Pmt>

   Credit Card Information
     Name on Card: <CCName>
     Card Number:  <CC#>  Exp. Date:    <ExpDate>

   First Virtual Information
     FV Account: <FV#>

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*If you include an email address, you will receive your serial number
via email within 48 hours after we receive this form.
**REMEMBER: If paying by Check/Money Order, be sure to include payment.
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