
Urlgrab v1.57 Registration Form

All information provided will be kept strictly confidential, and
will be used by the author solely for the purpose of record keeping
and acknoledging legitimate users of the software.

Contact:

Email this form to:                      Mail this form to:

Humberto J. Normey Gmez                 Humberto J. Normey Gmez

normeyh@usa.net                          Avda de Villajoyosa 95
normey@airtel.net                        3 Bloque 22
                                         03016, Alicante
                                         Spain.


I wish to register Urlgrab v1.57!

Name: _________________________________________________________

Company: ______________________________________________________

Address: ______________________________________________________

Town/City: ____________________________________________________

Country: ______________________________________________________

Post Code: ______________

Phone: __________________  FAX: ______________________

E-mail: ______________________________________________  (required for
 							 tech suport)


Payment:
  Urlgrab (Single user license) ........................... $5.00
  
  Payment within the European Union is preffered in an equivalent
  amount in Euros.
    
via
( ) cheque

( ) sending cash (should only be sent by registered post
		  to the address above)
( ) bank transfer to
        Banco Central Hispano
	Alicante, Urb. Capitan Segarra.
        
        Account Holder: Humberto Javier Normey Gmez.
	Account Number: 0049 3735 67 2994010111


Thank you for registering!
