PeerChat v2.0 Mail Order Form

Use  this  form  to  register PeerChat v2.0 by mail with Claudin Lambert, the
author of PeerChat. Accepted modes  of payments are bank drafts, postal money
orders, and company checks.  All prices and payments are in US dollars (USD).
The  mailing  address is at the bottom of this form.  There  are  also  other
registration methods and  last  minute  information  on  PeerChat  Website at
http://www.peerchat.com/register/

Each license costs $ 17.50 USD (1 license / computer). If you want to receive
a floppy disk or a CD-ROM you can still download the standard edition online.

[PERSONAL INFORMATION]

      First Name:

      Last Name:

      Company:

      Billing Address:


      City:

      State/Province:

      Zip/Postal Code:

      Country:

      Phone:

      Email Address:

[SHIPPING ADDRESS]

      [ ] Use billing address as shipping address.

      Name:

	  Phone:

	  Address:


      City:

      State/Province:          Zip/Postal Code:

      Country:

[ORDER INFORMATION]

      Product name:			PeerChat v2.0

      Number of Licenses:
      Price:  $17.50 per license  (    X  $17.50) =  $

      Order Type:
          [ ] Online Download.
          [ ] 1.44 Floppy Shipped.
          [ ] CD-ROM Shipped.

          Online Download: No Fee
          1.44 Floppy Shipped: $5 for US and Canada, $8 rest of world.
          CD-ROM Shipped: $9 for US and Canada, $14 rest of world.

      Pricing for shipping (charged once per order): $ 

      Total (licenses + shipping): $ 

    Message for "About" dialog box (Optional):

    Line#1:
    Line#2:
    Line#3:

Pay to the  order  of Claudin  Lambert  in US dollars and mail the form along
with your payment to the following address.

	Claudin Lambert 
	510-3525 Aylmer Street
	Montreal, (Quebec) H2X 2C1
	CANADA 

You  will be notified by E-mail as soon as your letter is received.  When the
payment  is  cleared by the  bank,  you  will  receive another E-mail message
containing  all  details  you  need  to  access  the  registered user area on
PeerChat Website where you will be able to download the standard edition.

If you chose to receive a floppy disk by mail, please allow about 4 weeks for
delivery (can take longer for orders  outside Canada and the USA).

Thank you!
Claudin Lambert
This document was formatted to fit on 2 pages when printed.