REGISTRATION FOR PAGEBUILDER

Product ID: 8542
Program Name: PageBuilder
Operating System: Win95/98
Registration: $45.00

Quantity: _____

Please be sure your email address is correct! This is how you will receive your registration confirmation.

HOTMAIL email addresses, and other email forwarding addresses are NOT accepted. Compuserve users please use a period (.) instead of a comma (,) 1234.567 not 1234,567.

BILLING INFORMATION

Email Address: _________________________________________________________

Name (as it appears on credit card): _______________________________________

Company Name (optional): _______________________________________________

Address (exactly as it appears on your statement):

                      __________________________________________________________

Address (cont): _________________________________________________________

City: _______________________________

State/Province: ______________________

Country: ____________________________

Postal Code: _________________________

Phone Number: _______________________

Credit Card Type: Visa / MasterCard / American Express / Discover (Novus)

Card Number: _________________________

Card Expiration Date: ___________________

Signature: _____________________________
By signing here you agree to pay the indicated fees billed by RegSoft.com to your credit card account for this order. You also agree to pay any legal fees incurred by RegSoft.com for the recovery of their costs in the event you dispute their charges.

Please tick here ____ if you wish to be billed an extra $24.95 ($19.95 + $5.00 S&H) for the RegSoft.com Shareware CD Volume 1.

Your card will be charged as RegSoft.com.

When completed, please mail this form to:

RegSoft.com Inc.
PMB 201
10820 Abbotts Bridge Road
Suite 220
Duluth, GA 30097

or fax to:

770-497-9234