dpw Designs Software Registration Form
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  Please print this form, fill out     |      dpw Designs
  the following items, attach a check  |      Software Registration
  or money order (U.S. funds only) and |      P.O. Box 192
  send to:                             |      Norco, CA  91760-0192  USA


  Name _____________________________________________________

  Address __________________________________________________

  City _________________________  State _____  ZIP _________

  E-mail ___________________________________________________  [required]

  Pilot User Name __________________________________________  [required]

  [ NOTE:                                                               ]
  [ If you are not sure what your Pilot User Name is, run the HotSync   ]
  [ application on your handheld organizer. On the Pilot, PalmPilot and ]
  [ WorkPad models, your Pilot User Name follows the text "Welcome". On ]
  [ the Palm III and Symbol SPT 1500, it is located in the upper right  ]
  [ corner of the screen.                                               ]


  Product                          Qty          Price
  ----------------                 ------       ------
  Convert-It!                      [    ]   x   $10.00   =   $ _________

  Lease-It!                        [    ]   x   $10.00   =   $ _________

  Postal Delivery (MS-DOS format 3.5" diskette)  $4.00   =   $ _________
    
                                                       TOTAL $ _________


  Upon receipt of your order, you will be sent an e-mail message (or
  optional postal delivery) containing the current version of the
  requested software and a key to turn off the registration reminder.

  We would appreciate your comments:

    How did you hear about us? _________________________________________

    ____________________________________________________________________

    What other products would you like to see from us? _________________

    ____________________________________________________________________

    Additional comments: _______________________________________________
