		Image Edger - Full Version Order Form
		-------------------------------------

Program No.: 133364

Last name: ___________________________________

First name: ____________________________________

Company: ____________________________________

Street and #: ______________________________________

City, State, postal code: ________________________________

Country: _______________________________________

Phone: _____________________________________

Fax: ________________________________________

E-Mail: ______________________________________

** Please do not forget to include your e-mail address.     **
** The Full Version will be e-mailed to you at this address **


Registration fee US $: 11.95

How would you like to pay the registration fee:
			
	[  ] credit card	[  ] wire transfer 
	[  ] EuroCheque		[  ] cash

Credit card information (if applicable):
			
	[  ] Visa 		[  ] Eurocard/Mastercard 
	[  ] American Express 	[  ] Diners Club


Card holder: ________________________________


Card No.: ______________________ Expiration Date: ________


Date / Signature: ___________________________