
MDS PowerBase Registration Form

Please fill out the following information and mail $ 50.00 (US dollars)
and this form to:

	Make Check Payable To:	Mike Sachais
				3857 Foxwood Rd.
				Duluth, GA 30136

Upon receipt of registration, you will be sent a product registration
number to make MDS PowerBase fully functional.

****   Thank you for using MDS PowerBase   ****

SITE LICENSE INFORMATION:

	For information about registering an unlimited use site license
	please contact Mike Sachais by phone at	(404) 416-8821.

_________________________________________________________________________


Name:_______________________________

Address:_________________________________

	_________________________________

   City:________________________    State:__________   Zip Code:____________

Phone Number:_(______)____________________

Company Name:_______________________________

Occupation:___________________________________

The Product Serial Number can be found on the MDS PowerBase Registration
Window and is required to register this product.

   Product Serial Number:____________________


Would You Like Your Product Registration Number Faxed To You ?  Yes   No

   If Yes, What Is Your Fax Number:_(______)____________________

What release of MDS PowerBase do you have ? _____________

How did you first receive MDS PowerBase ? :

What databases do you plan to access with this product ?

What other products are you currently using to access your databases ?
