LView Pro 1.D2 -- Site Registration Form
 
1. Site information (please PRINT):
 
Site Name: ________________________________________________________
Authorized representative: ________________________________________
Address line 1:____________________________________________________
Address line 2:____________________________________________________
City: _____________________ State: _______________ ZIP: ___________
Country (if other than USA): ______________________________________
Phone number: (____)_______________ Date (MM/DD/YY): ____/____/____
Email address:_____________________________________________________
 
2. Payment and fees:
 
Fees are in US dollars, please do not send cash. Checks and money 
orders must be made payable to MMedia Research. Select form of 
payment (check one):
 
__ Enclosed check or money order
__ Credit card payment:
   ( )VISA ( )MasterCard ( )AMEX ( )Discover
   Name on card: _____________________________
   Card Number: ______________________________
   Expiration Date (MM/YY): _____/_____
   Signature (required if form is faxed/mailed): _________________
 
3.1 Pricing for the use of LView Pro 1.D2 or newer, per site computer 
   (Please write for pricing on quantities over 99 computers):

 1st computer at $30.......................................= $ 30.00
 2nd to 24th computer at $20 each................____ x 20 = $______
25th to 99th computer at $17 each................____ x 17 = $______
Total licensing............................................= $______

3.2 Shipping and Handling

Email delivery of site name and ID is free worldwide.......= $ 0.00
CD-ROMs shipped WITHIN USA at $10.00 each........____ x 10 = $______
CD-ROMs shipped OUTSIDE USA at $18.00 each.......____ x 18 = $______
1.44 disks shipped WITHIN USA at $5.00 each......____ x  5 = $______
1.44 disks shipped OUTSIDE USA at $12.00 each... ____ x 12 = $______
Total shipping and handling................................= $______

3.3 Totals

Add total licensing (3.1) + total S&H (3.2)................. $______
Florida sites please add appropriate sales tax...............$______
Grand total..................................................$______

4. Mail this form together with payment to:
 
   MMedia Research Corp
   LView Pro Registration
   1501 East Hallandale Beach Boulevard, #254
   Hallandale - FL - 33009
   USA
 
*** If credit card payment was selected, this form may be faxed to 
    954-458-9698 (Florida, USA) or emailed to register@lview.com
