

========================================================================
|     Register: FaxMail for Windows, FAX-V200.ZIP, 1-713-261-0307      |
| ElectraSoft, 3207 Carmel Valley Drive, MISSOURI CITY, TX  77459-3068 |
|== Please Print ======================================================|
|                                                                      |
| Date___/___/___ Country________________ Wk Phone____________________ |
|                                                                      |
| Name___________________________________ Hm Phone____________________ |
|                                                                      |
| Address________________________________ Fx Phone____________________ |
|                                                             _        |
| City_______________________________ State_____ ZIP__________________ |
|======================================================================|
| Disk Size:  __3.5-1.4MB  __5.25-1.2MB  __Other______________________ |
|-----+----------------------------------------------------------------|
| Qty | Item                                                 Amount    |
|-----+----------------------------------------------------------------|
|     |                                                                |
|_____| FaxMail for Windows - - - - - - - - - - - - - $25.00 $_____.__ |
|     |                                                                |
|_____| OCR - - - - - - - - - - - - - - - - - - - - - $20.00 $_____.__ |
|     |                                                                |
|_____| Edit Fax  - - - - - - - - - - - - - - - - - - $10.00 $_____.__ |
|     |                                                                |
|_____| DCX to PCX Breakup  - - - - - - - - - - - - - $10.00 $_____.__ |
|     |----------------------- or --------------------------           |
|_____| All of the above ($10.00 savings) - - - - - - $55.00 $_____.__ |
|----------------------------------------------------------------------|
|                                                                      |
| Price of Merchandise  - - - - - - - - - - - - - - - - - -  $_____.__ |
|                                                                      |
| Registration, Shipping, and handling  - - - - - - -  $4.00 $____4.00 |
|                                                                      |
| Texas residents, please, add Sales Tax (8.25%)  - - - - -  $_____.__ |
|                                                                      |
| Total (Pay this amount) - - - - - - - - - - - - - - - -  US$_____.__ |
|----------------------------------------------------------------------|
|   __VISA            __MC            __DISCOVER            __Check    |
|                                                                      |
| Card Number_____________________________________ Exp Date___/___/___ |
|                                                                      |
| Print name as it appears on card____________________________________ |
|                                                                      |
| Signature_____________________________________ Date Today___/___/___ |
|                                                                      |
|======================================================================|
| FAX Orders:                                                          |
| Call ElectraSoft at 1-713-499-5939,11,11,11,11                       |
|                                                                      |
| Phone Orders:                                                        |
| Call ElectraSoft at 1-713-261-0307                                   |
|                                                                      |
| Mail Orders:                                                         |
| ElectraSoft, 3207 Carmel Valley Drive, MISSOURI CITY, TX  77459-3068 |
|                                                                      |
| Where did here about FaxMail for Windows____________________________ |
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| Optional; to help us better serve you:                               |
| Which Fax/Modem-Driver works best (found in your AUTOEXEC.BAT):      |
| __FM_ROCK2.COM  __FM_ROCK1.COM  __FM_ATT1I.COM  __FM_ATT2I.COM       |
| __FM_PP1.COM    __FM_CLS2I.COM  __FM_CLS2E.COM  __FM_DOVE1.COM       |
| __FM_DALAS.COM  __FM_ZOOM2.COM  __FM_ZYXEL.COM  __FM_CLAS1.COM       |
| __CAS(none) Fax/Modem Brand/Mod#____________________________________ |
| Data Speed: __1200bps __2400bps __9600bps __14400bps __Other________ |
| FAX Speed:  __1200bps __2400bps __9600bps __14400bps __Other________ |
| Supported: __HST __V.32 __V.32bis __V.42bis __Other_________________ |
| Computer Brand______________________________________________________ |
| Processor: __8088 __80286 __80386 __80486 __Other___________________ |
| Machine Speed: __25Mhz __33Mhz __50Mhz __66Mhz __Other______________ |
| Display Type: __CGA __EGA __VGA __SVGA __Other______________________ |
| Floppy Drive(s): __3.5, 1.4MB __5.25 1.2MB __Other__________________ |
| HardDrive Brand/Mod#______________________________ size___________MB |
| Bugs or suggested improvements (print on back)______________________ |
| ____________________________________________________________________ |
| ____________________________________________________________________ |
| ____________________________________________________________________ |
| ____________________________________________________________________ |
| ____________________________________________________________________ |
| Signature_________________________________________ Date_____________ |
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