Software Products Order/Registration Form

    SciTech Software                            Date: (dd/mm/yy) ___/___/___
    GPO Box 4216NN
    Melbourne Victoria 3001                      ** Please read PRODUCTS.DOC
    AUSTRALIA                                       for ordering information
    Fax: +61 3 690 2137

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

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

    Computer: [ ] 386 PC [ ] 486 PC [ ] Pentium PC [ ] Macintosh
              [ ] Other (please specify) ___________________________________

    OS:       [ ] MSDOS  [ ] OS/2   [ ] Windows NT [ ] Unix
              [ ] Other (please specify) ___________________________________

    Pay By:   [ ] Cheque (Aust. Only)  [ ] Money Order  [ ] Credit Card

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

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

    SC Product (see PRODUCTS.DOC for details)      Cost   Qty     Price
       --------------------------------------      ----   ---     ------
    A  Universal VESA VBE                          A$20   ___  A$ ______
    A  Universal VESA VBE Source Code              A$75   ___  A$ ______
    C  MegaToolbox (MTL)                           A$49   ___  A$ ______
    C  MegaToolbox (MTL) w/src                     A$299  ___  A$ ______
    C  MegaGraph Graphics Library (MGL)            A$99   ___  A$ ______
    C  MegaGraph Graphics Library (MGL) w/src      A$599  ___  A$ ______
    A  Freeware C++ (TECH, MVIS, MGL2D, MGL3D)     A$30   ___  A$ ______
    A  Miscellaneous freeware                      A$20   ___  A$ ______

      Disk size:   [ ] 3.5"     [ ] 5.25"

      Subtotal:                                             A$ ______
      Shipping Charges (see PRODUCTS.DOC for amount!):      A$ ______
      Total Enclosed:                                       A$ ______

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

      (Signature) _____________________________________________________








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