MAXI FORM SHAREWARE REGISTRATION FORM 
 
        Fill out this form and mail with your cheque, money order or VISA card 
        number to: 
 
             Herne Data Systems Ltd., PO Box 250, Tiverton, ON, CANADA  N0G 2T0 
 
        Please register my copy of MAXIFORM for $10 (US or CDN),              [ ] 
        plus $2 p & h (for US & Canada), $4 p & h elsewhere. 
 
        Please register me for a Site/LAN license for $100 (US or CDN)        [ ] 
        plus $2 p & h (for US & Canada), $4 p & h elsewhere. 
 
        Please send me the Herne Data Systems Shareware Evaluation Pak for    [ ] 
        $5 plus $2 p & h (Evaluation copies of all Herne Data Systems  
        shareware products including MAXI-Form, Utility_Belt, Over_LAZ  
        for LaserJet, Over_LAZ for PostScript and NPS Nominal Pipe Size) 
        (1.2 meg or 1.44 meg high density disk only) 
 
        Disk size required       3.5" [ ]            5.25" [ ] 
 
        Where did you get your copy of MAXI Form (shareware vendor, BBS, etc)? 
 
        _______________________________________________________________________ 
 
        Cheque or money order enclosed   [ ]    or charge my VISA card*  [ ]    
 
 
        VISA # _____/_____/_____/_____     Expiry __/__   Total Amount* __________ 
 
        Phone # (_____) _____-________     Signature _____________________________ 
 
        NOTE:     * All VISA orders will be charged in CANADIAN DOLLARS.   
                    VISA orders can be FAXed to (519) 366-2732 for faster service. 
 
        Name      __________________________________________________________ 
 
        Address   __________________________________________________________ 
 
        City      ____________________________       Prov/State_____________ 
 
        Zip       ____________________________       Country   _____________ 
 
        Canadian orders include GST.  PST must be added to total charge for 
        ONTARIO residents.  Payment for international orders can be made by VISA 
        card, international money order (in US$ or CDN$), or Eurochecks in the 
        currency of the issuing country (e.g. Sterling, Francs and most other 
        other major currencies). 
 
        All orders are shipped by first class air mail.  Please allow two weeks 
        for delivery.  Sorry, we cannot accept MasterCard or COD orders. 
 
 
        (v1.8 93-12-01)