    To:	David Aylott
	2/35 Bertram Street
	Elsternwick VIC 3185
	Australia

   From (Please PRINT):

        Name / Company: __________________________________
 
                Street: __________________________________

         City, Country: __________________________________

  	  E-mail / Fax: __________________________________


    1.  Program to register: ____HELPDESK DATABASE________

    2.  Registration fee: US$____________________

    3.  Number of PCs this will run on: _________

    4.  Postage / Fax fee: US$___________________
	(not required if registering via e-mail)

	US$1.00 for postage or fax within Australia
	US$2.00 for postage or fax outside of Australia


    5.  TOTAL Registration fee: US$_______________
	(or the equivalent in your local currency)

    6.  Method of Payment: _________________________________________
	(eg cash or cheque)

    7.	Registration Name:__________________________________________
	(This name MUST be included and will appear on several forms
	and reports. Please specify EXACTLY how you want the name to
	appear using UPPER and lower case and up to 40 characters).


	Signature: _______________________________  Date: __________


	Which version of HELPDESK are you using: ___________________

        Where did you discover HELPDESK: ___________________________

	Comments / Suggestions: ____________________________________

	____________________________________________________________
