Registration Form  - The Login Checker (Ver 3.0)
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Send to:      Tamalpais Technologies
	      c/o Login Checker 
	      P.O. Box 125
 -or-         Larkspur, CA  94977

Fax to:       (415) 927-4619              Date: ________________

Name:         _________________________________________

Title:        _________________________________________

Company:      _________________________________________

Address 1:    _____________________________________________________

Address 2:    _____________________________________________________

City:         _____________________________ State: ________ Zip: _____________

Country:      _____________________________ (if outside the U.S.)

Phone Number: _____________________________

Disk Size:          5 1/4       3 1/2       (Circle One)

Method of Payment:  _____ Check (Inclosed)    

		    _____ Bill Me! (Send an Invoice)  - PO Number  _________________

                    _____ Credit Card ( Circle One:   VISA - MASTERCARD - AMEX )
		    
	Credit Card #:  ____________________________________  exp: _________

	Full name on Card: ___________________________________
	
	Signature (only for CC orders): _____________________________________


Please register me for (one location):

   1 To  50 users   ____________  $35                    

   51 to 100 users  ____________  $70

   101 to 150 users ____________  $105

   151 to 200 users ____________  $140

   201 to 250 users ____________  $175

   251 to 300 users ____________  $210

   Over 300 users   ____________  $245

   Corporate Wide Site License 
   (Unlimited users, All Sites) : ___________  $750

				       
			 Order Total:   __________________
				
					     $2.50
	       Shipping and Handling:   __________________
	
   California? (add 7.25% Sales Tax):   __________________
					     
			       Total:   __________________




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Please help us get you the products you want by anwsering a
few questions (Thank you):
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Where did you hear about the Login Checker (please circle one)?
				      
  Compuserve      AOL   Internet   BBS   Word of Mouth  CD-ROM   
  
  Disk in Book     Magazine    Internet    Your web page
  
  Other____________________________________________________

What was the name of the service, forum, book, or CD-ROM that you
download the Login Checker from?

______________________________________________________________

Any comments about the product (New features you'd like to see?)
				      
_____________________________________________________________________

_____________________________________________________________________


F#2 (08/96)
