                              BMT Micro Order Form
                              ====================
Fax To                                                          Mail To

910-350-2937                  V - The File Viewer               BMT Micro
                                                                PO Box 15016
                                                                Wilmington
                                                                NC  28408

Order Details
=============

 ___ I want to purchase a single user license for V @ $20

 ___ I want to purchase a site license for the following number of users
       (enter the number of users in the appropriate section).

  ....  2-9  users @ $20 each    .... 50-99 users @ $11 each

  .... 10-24 users @ $17 each    .... 100-499 users @ $8 each

  .... 25-49 users @ $14 each    .... Unlimited License - $4,000


Total value of order   $________

[All amounts are in $US]
[Residents of North Carolina must include the relevant sales tax]

Registration Details
====================

Name (First/Last)    ......................................................

Company name         ......................................................
(if applicable)

Address              ......................................................

                     ......................................................

City                 ......................................................

State/Province       ....................  Zip/Post Code  .................

Country              ......................................................

Email address        ......................................................

Contact Phone #      ........................  Fax#  ......................

Registered User Name ......................................................
                      (This is the name that will appear on the About Box)

Payment Details
===============

 ___ Check/Money Order attached (made out to BMT Micro), or

Credit card number
(MC, Visa, Amex, Discover)    .............................................

Expiration Date (MM/YY)       ............


Signature                     .............................................


Complete the following section ONLY if DIFFERENT from the above name/address.

Credit Card Holder's Name & Address

Name on Credit Card  ......................................................

Company name         ......................................................
(if applicable)

Address              ......................................................

                     ......................................................

City                 ......................................................

State/Province       ....................  Zip/Post Code  .................

Country              ......................................................

