Software Products Order/Registration Form

    SciTech Software                            Date: (dd/mm/yy) ___/___/___
    97 E. St. James #44
    San Jose, CA 95112
    USA
    Phone: 1-800-4UNIVBE (USA & Canada orders only)
           +1-408-292-4476
    Fax:   +1-510-208-8026

    Name: __________________________________________________________________
    Company: _______________________________________________________________
    Address: _______________________________________________________________
             _______________________________________________________________
             _______________________________________________________________
    Phone: ___________________________________  Fax: _______________________
    Email: _________________________________________________________________

    Register product(s) to: [ ] Company     [ ] Individual

    Pay By:   [ ] Cheque (USA only)  [ ] Money Order  [ ] Credit Card

    Credit Card Orders: MasterCard / Visa (circle one):

        Card Number ___________________________________ Expires ___/___
        Exact name on card (print) ____________________________________
        Signature (REQUIRED) __________________________________________

    For mail orders from outside of the USA & Canada, the shipping charge is
    US$5 and will be delivered via airmail. For orders within the USA &
    Canada, the shipping charge is US$3.

      Product                                  Cost        Qty   Price
      ------------------------------------     -----       ---   ------
      UniVBE/Pro 4.x Upgrade                   US$16*      ___ $ ______
      UniVBE/Pro 4.x Upgrade, Disk + Manual    US$26*      ___ $ ______
      UniVBE/Pro 5.x                           US$28*      ___ $ ______
      UniVBE/Pro 5.x, Disk + Manual            US$38*      ___ $ ______

      Disk size:   [ ] 3.5"     [ ] 5.25"

    *Includes all 5.x upgrades (available online)

      Subtotal:                                                $ ______
      CA residents add 8.25% sales tax:                        $ ______
      Shipping Charges (See above for amount!):                $ ______
      Total Enclosed:                                          $ ______

    I have read and agree to abide by the enclosed license agreement:

      (Signature) _____________________________________________________









    Software Tools Order/Registration Form                      Page: 1