UniVBE Order/Registration Form SciTech Software ___/___/___ 5 Governors Lane, Suite D MM/DD /YY Chico, CA 95926 USA Toll free/Phone/Fax: 800-4UNIVBE/916-894-8400/510-208-8026 PLEASE PRINT OR TYPE CLEARLY! Name: __________________________________________________________________ Company: _______________________________________________________________ Address: _______________________________________________________________ __________________________________Zip/Postal Code______________ ______________________________________ Country ________________ Phone: ___________________________________ Fax: _______________________ Email: _________________________________________________________________ Register product(s) to: [ ] Company [ ] Individual Pay By: [ ] Cheque (USA only) [ ] Money Order [ ] Credit Card Credit Card Orders: MasterCard / Visa / American Express(circle one): Card Number ___________________________________ Expires ___/___ Exact name on card (print) ____________________________________ SHIPPING CHARGES: If a disk & manual are ordered from outside of the USA, the shipping charge is US$7 and will be delivered via airmail. For orders within the USA, the shipping charge is US$3. Orders without disk & manual will receive a receipt and registration code via airmail for no additional shipping charge. Price List Cost Qty Price ------------------ ------------------ ----- --- ------ Upgrade from UniVBE/Pro 4.x (registered) US$16* ___ $ ______ UniVBE/Pro 5.x US$28* ___ $ ______ Manual + Disk [ ] 3.5" [ ] 5.25" US$10 ___ $ ______ *Includes all 5.x upgrades (available online) Subtotal: $ ______ CA residents add 7.25% sales tax: $ ______ Shipping Charges (See above for amount!): $ ______ Total Enclosed: $ ______ I have read and agree to abide by the enclosed license agreement and I agree to be bound by my credit card agreement. (Signature required) ________________________________________________