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  1. ┌──────────────────────────────────────────────────────────────────────┐
  2. │ Backup Fugue v1.1 registration form                                  │
  3. │ Return to:     Fugue Software           Voice +61 7 824 2843         │
  4. │                P.O. Box 425              Fax  +61 7 824 2843 (same)  │
  5. │                CAPALABA  QLD 4157       Compuserve 100036,311        │
  6. │                AUSTRALIA          Internet 100036.311@compuserve.com │
  7. │                                                                      │
  8. │ Name ______________________________________________________________  │
  9. │                                                                      │
  10. │ Company ___________________________________________________________  │
  11. │                                                                      │
  12. │ Address ___________________________________________________________  │
  13. │                                                                      │
  14. │         ___________________________________________________________  │
  15. │                                                                      │
  16. │ Diskette size:     ____ 5.25" acceptable       ____ 3.5" required    │
  17. │                                                                      │
  18. │                    [ ]  please send high density disks only          │
  19. ├──────────────────────────────────────────────────────────────────────┤
  20. │Please send me a registered copy of Backup Fugue (with printed manual)│
  21. │                                                                      │
  22. │   Check here for information on:    [__] Multi-system Licenses       │
  23. │                                     [__] Reseller Pricing            │
  24. │                                     [__] Catalog of products         │
  25. │                                                                      │
  26. │ Where did you hear about Backup Fugue? _____________________________ │
  27. │                                                                      │
  28. │  __________________________________________________________________  │
  29. │                                                                      │
  30. │  I agree to abide by the Backup Fugue License agreement.             │
  31. │                                                                      │
  32. │   Signed                                                             │
  33. ├──────────────────────────────────────────────────────────────────────┤
  34. │                                               Quantity   Price       │
  35. │ Backup Fugue Complete package                                        │
  36. │    (disks plus printed manual)                                       │
  37. │     ( AUD $55    USD $39   UK £27 )           ________   __________  │
  38. │ Backup Fugue Disks only                                              │
  39. │     ( AUD $39    USD $27   UK £20 )           ________   __________  │
  40. │ Backup Fugue Additional manual (no disks)                            │
  41. │     ( AUD $25    USD $20   UK £14 )           ________   __________  │
  42. │                                                                      │
  43. │ Shipping charges, per copy:                              __________  │
  44. │                                                                      │
  45. │ Postage to:                    Total enclosed:           __________  │
  46. │ Australia       $5 AUD                                               │
  47. │ New Zealand     $7 AUD    $8 NZD                                     │
  48. │ USA            $15 AUD   $12 USD                                     │
  49. │ UK & Europe    $20 AUD   $16 USD     £10 UK                          │
  50. │                    I wish to pay by:                                 │
  51. │     [ ]   Visacard                     [ ]   Cheque                  │
  52. │     [ ]   Mastercard                   [ ]   Bankcard (Australia)    │
  53. │                                                                      │
  54. │Credit Card:  __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __   │
  55. │                                                                      │
  56. │ Expiry Date:  ___/___ Name: _________________________________________│
  57. │                                                                      │
  58. │ Signature :                                                          │
  59. └──────────────────────────────────────────────────────────────────────┘
  60.