==================== TinyPort Registration Form ================

>>>  IMPORTANT NOTE: please use this form ONLY if there is no
>>>  other way for you to pay than by mailing a US dollar check.

>>>  Otherwise, use the form in REGISTER.TXT.


Name: _____________________  Company: __________________________

Address: _______________________________________________________

City, State, Zip: _________________________  Country: __________

E-Mail: _________________________________________  Date: _______

TinyPort shall be registered to (please check ONE)

     _  my NAME, exactly as spelled above

     _  my COMPANY, exactly as spelled above

     _  instead to: ________________________________


TinyPort License (see LICENSE.TXT for details)
                      ____  copies at $65 each =         $ _____

Customers in the EC add 16% VAT,                       + $ _____
  OR give us your VAT Nr.: _____________________

Check fees
  (sorry, but those German banks ...)                        +$4

                         Total payment                   $ _____


________________________________________________________________

Please mail this form, together with your check, to:

Manfred Keul GmbH, Landsbergstr. 16, D-50678 Koeln, Germany


