Please fill out this form and send it to:

 Holger Kruse
 12006 Coed Drive
 Orlando, FL 32826
 USA

The information you provide will be treated confidentially.

Registration form for ppp.device, Amiga-version
-----------------------------------------------

Name:         ________________________________________________

Street:       ________________________________________________

City, ZIP:    ________________________________________________

Country:      ___________________  Phone: ____________________

E-Mail:       ________________________________________________


Amiga model:  ___________________    CPU: ____________________

Type of PPP host(s) connecting to (Please give as much
information (hardware/software etc.) as possible. This helps me
find potential compatibility problems and improve ppp.device):

______________________________________________________________

______________________________________________________________

______________________________________________________________

______________________________________________________________


I would like to become a registered user of the Amiga-version of
ppp.device and obtain a non-exclusive single-site license. Please
send me my keyfile and the latest version of ppp.device

   [ ]  on 880 kB Amiga floppy disk

   [ ]  by some other means: _________________________________


I have enclosed US$ 15 in [ ] cash, [ ] check, [ ] money order.


I agree to keep the keyfile secret and acknowledge that
disclosure of the keyfile or tampering with the keyfile is
considered software piracy and terminates my license.


_____________________________     ____________________________

(city, date)                      (signature)
