
                        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) ________________________________________________

