Category : Printer + Display Graphics
Archive   : MOSVGA.ZIP
Filename : REGIS.DOC

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|| REGISTRATION INVOICE ||
|| FOR MOSAIX ||
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Date: ____________________ MOSAIX Version: _____________________

Name: ___________________________________________________________

Company: ________________________________________________________

Address: ________________________________________________________

City: ________________________ State: __________ Zip: ___________


_________ MOSAIX Registration only ($35) ............ $__________
(Includes 1 Free Color Scan)

_________ MOSAIX Registration & Update ($45) ........ $__________
(Includes 1 Free Color Scan, Update and ARGUS Utility)

___ 1 ___ FREE Color Scan of your slide or print .... $__ 0.00 __
[ ] VGA / MCGA [ ] EGA

_________ Additional Color Scans ($25 per image) .... $__________
[ ] VGA / MCGA [ ] EGA

_________ 3.5" Disk Media Surcharge ($3)............. $__________

Disk format: SHIPPING ($3): $__________

[ ] 5.25" OHIO SALES TAX (5.5%): $__________

[ ] 3.5" TOTAL PAYMENT: $__________

[ ] Mastercard [ ] Visa [ ] Check [ ] Money Order

Card #: ___________________________________ Exp. Date: __________

Signature: ______________________________________________________

Optional Information

Computer: ____________________ Dos Version: _____________________

Memory: ______________________ Disk: ____________________________

Monitor: _____________________ Adapter:__________________________

Where did you get MOSAIX from: __________________________________

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|| Please mail to: | Phone Orders: ||
|| | ||
|| Data Assist | (614) 888-8088 ||
|| 651 Lakeview Plaza, Suite G | ||
|| Columbus, Ohio 43085 | Thank you for your support!! ||
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