Registration Form  - The Login Checker
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Send to:      Tamalpais Technologies
              c/o Login Checker
              P.O. Box 125
              Larkspur, CA  94977


Name:         _________________________________________

Title:        _________________________________________

Company:      _________________________________________

Address 1:    _____________________________________________________

Address 2:    _____________________________________________________

City:         _____________________________ State: ________ Zip: _____________

Country:      _____________________________ (if outside the U.S.)

Phone Number: _____________________________


Disk Size:          5 1/4       3 1/2       (Circle One)

Method of Payment:       
                    _____ Check     

                    _____ Cash

                    _____ Money Order   
 
                    _____ COD (add $2)  

                    _____ Bill Me!  (Send an Invoice)  (PO Number ____________)


Total inclosed (or for the invoice):

        
        Number of Servers ____________   x  $25  =    __________________


                   California? (add Sales Tax 7.25%)  __________________

                                  COD? (add $2.00)    __________________
 

                                             Total    __________________

                                
I wish to register for The Login Checker for the $25 per file server
(US Dollars) registration price, using the method of payment specified above.  
I wish to receive the most current version of The Login Checker along with a 
manual and the ability to get free phone support.