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  1. ┌──────────────────────────────────────────────────────────────────────┐
  2. │ Backup Fugue v1.1 registration form                                  │
  3. │ Return to:     Pik A Program Inc                                     │
  4. │                13 Saint Marks Place                                  │
  5. │                New York, NY  10003                                   │
  6. │                USA                                                   │
  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)   ($39/copy)   ________   __________  │
  37. │ Backup Fugue Disks only                                              │
  38. │                 (USD $27)                     ________   __________  │
  39. │ Backup Fugue Additional manual (no disks)                            │
  40. │                 (USD $15)                     ________   __________  │
  41. │                                                                      │
  42. │ Shipping charges, per copy:                              __________  │
  43. │                                                                      │
  44. │                                Total enclosed:           __________  │
  45. │ Postage to:   USA        International                               │
  46. │ Disks Only    $4          $8                                         │
  47. │ Manual Only   $6         $12                                         │
  48. │ Manual & Disk $6         $12                                         │
  49. │                    I wish to pay by:                                 │
  50. │     [ ]   Visacard                     [ ]   Check                   │
  51. │     [ ]   Mastercard                                                 │
  52. │     [ ]   Discover                     [ ]   American Express        │
  53. │                                                                      │
  54. │Credit Card:  __ __ __ __ - __ __ __ __ - __ __ __ __ - __ __ __ __   │
  55. │                                                                      │
  56. │ Expiry Date:  ___/___ Name: _________________________________________│
  57. │                                                                      │
  58. │ Signature :                                                          │
  59. └──────────────────────────────────────────────────────────────────────┘
  60.