                            E-Teller Registration Form
                            ~~~~~~~~~~~~~~~~~~~~~~~~~~
                                    Version 1.7
                                    ~~~~~~~~~~~

   Thank you for registering E-Teller.  Your registration entitles you to free 
   upgrades to all future releases of E-Teller.  

   Please take a minute to fill out the form below, and send it along with your 
   registration fee (cheques or money order only, please) to:  

      Paul H. Caron
      c/o Mr. J-P Caron
      A10-420 Westmount Ave.
      Sudbury, Ontario  P3A 5V4
      CANADA


   Name ____________________________________________________________ 

   Address ____________________________________________________________ 

   City ______________________________ Prov./State _________________ 

   Postal/Zip Code _______________________ Country _________________ 

   E-Mail Address _____________________________________________________ 


   _______ Version Number

   _______ Number of copies

   _______ @ $20 US ($25 Canadian)

   _______ Enclosed payment


   If you have any comments or suggestions, please jot them below:  
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