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  1.  
  2. NET_MEM (TM) SHAREWARE REGISTRATION FORM
  3.  
  4.  
  5. Name:____________________________________________________________
  6.  
  7. Address:_________________________________________________________
  8.  
  9. Address:_________________________________________________________
  10.  
  11. City:_______________________________ State:______________________
  12.  
  13. Postal Code:________________________ Country:____________________
  14.  
  15.  
  16. Quantity         Description                 Price          Total
  17. -----------------------------------------------------------------
  18.  
  19. ________  Personal Net_Mem Registration      $  39.00       _____
  20.  
  21. ________  Commercial Net_Mem Registration    $  99.00       _____
  22.  
  23. ________  Governmental Net_Mem Registration  $ 199.00       _____
  24.  
  25. ________  Unlimited User Site License        $ 250.00       _____
  26.  
  27. ________  Non-Exclusive Source Code License  $ 500.00       _____
  28.  
  29.           Shipping                           $   7.00      $ 7.00
  30. -----------------------------------------------------------------
  31.  
  32.           Total                                            $_____
  33.  
  34. Please send all orders to Richard Levey
  35.                           1 Pace Plaza, T-1506
  36.                           New York, New York 10038 USA
  37.  
  38. Please allow a minimum of 2 weeks for delivery.
  39.