Anonymity 4 Proxy ver. 2.5 order form
=====================================================================

Mail this form to:	RegSoft.com, Inc.
                        PMB201
                        10820 Abbotts Bridge Road
                        Suite 220
                        Duluth, GA 30097
                        USA   

Or fax it to:		770-497-9234
			

Or just call:		1-877-REGSOFT (U.S. customers)
			770-319-2718  (other countries)


Check, money order or credit card order accepted
---------------------------------------------------------------------
Note: for mailed orders, the checks need to be in US Dollars and made
out to "Regsoft.com Inc".

A purchase order must be faxed or mailed to the address listed above
with all necessary information including billing information.


Order Information
======================================================================

Anonymity 4 Proxy 2.5
Non-commercial License (Product ID# 15209) Price/Unit   Q-ty     Total
----------------------------------------------------------------------
License for a server     Special Offer
and two client computers Price Code C914F  $35.00      ____   _______



Anonymity 4 Proxy 2.5
Business License       (Product ID# 31163) Price/Unit   Q-ty     Total
----------------------------------------------------------------------
License for a server 
and two client computers                    $65.00      ____   _______


Anonymity 4 Proxy 2.5
LAN License            (Product ID# 17942) Price/Unit   Q-ty     Total
----------------------------------------------------------------------
License for a server 
and 15 client computers                     $149.00     ____   _______



TOTAL AMOUNT (US Dollars) 		      	    	       _______


!! !!  Software will be delivered to you by e-mail.         !! !!
!! !!  Double-check that your e-mail address is correct!    !! !!


Payment Information
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
First Name:      _____________________________________________________

Last Name:       _____________________________________________________

Company:         _____________________________________________________

Street Address:  _____________________________________________________

                 _____________________________________________________

City: 		 _____________________________________________________

State/Province:  _____________________________________________________

Zip/Postal Code: _____________________________________________________

Country:         _____________________________________________________

Daytime Phone:   _____________________________________________________

Fax:             _____________________________________________________

Email Address:   _____________________________________________________

Payment:         __ MasterCard     __ VISA     __ AMEX     __ Discover
                 __ Check       __ Money order       __ Purchase order


For credit card orders:

Name on Card: ________________________________________________________

Credit Card Number: __________________________________________________  

Expiration Date: month _______________ year (4 digits) _______________


                Signature : ____________________  Date: ______________
