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TO: Siu Fung Chan
Unit 1208, Wan Loi House,
Wan Tau Tong Tsuen, 
Tai Po, N.T.,
Hong Kong

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	~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
	WebMirror(TM) 1.1 Registration Form
	~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~


User Name: _____________________________________

User E-mail: ___________________________________

Address: _______________________________________

City, State, Zip: ______________________________

Country: _______________________________________

Occupation*: ___________________________________

Fax*: _________________

I am ordering
[ ] a license costing US$10.00
[ ] ___ licenses each costing US$10.00, 
    total US$____

------------------------------------------------
NOTE: 
  Your user name and e-mail address are very 
  important. A different user name is needed
  for each license. Please double-check to
  ensure correctness.
------------------------------------------------

Check or Money Order Number:

________________________________________________

Bank: __________________________________________

Remark: 
* Optional information
