SciTech Display Doctor 5.3a
Order/Registration Form (AUSTRALIAN CUSTOMERS ONLY)

    SciTech Software Australia					    ___/___/___
    9 Mitchell St						 		    MM /DD /YY
    Richmond, 3121 AUSTRALIA
    Phone: (03) 9428-9810                               Fax: (03) 9428-9676

PLEASE PRINT CLEARLY OR TYPE!

    Name: _________________________________________________________________

    Company: ______________________________________________________________

    Address: ______________________________________________________________

    City: ________________________________  State: ________________________

    Post Code: _____________________  

    Phone: _______________________________  Fax: __________________________

    Email(required for email orders):______________________________________

    Register product(s) to: [ ] Company     [ ] Individual

    Pay By:   [ ] Check (Aust. only)  [ ] Money Order  [ ] Credit Card
                   *$15.00 charge for all returned checks

    Credit Card Orders: MasterCard / Visa / Bankcard (Circle one)

    Card Number ______________________________________   Expires ____/____

    Cardholder's name (print) ____________________________________________

                 Item                               Cost      Qty   Price
-------------------------------------------       --------    ---   ------
Windows/DOS (Windows based install)
  SciTech Display Doctor 5.3a w/Disk               A$44.95    ___ $ ______
  SciTech Display Doctor 5.3a w/Disk & Manual 	   A$56.95    ___ $ ______

DOS Only (DOS based install)
  SciTech Display Doctor 5.3a w/Disk               A$44.95    ___ $ ______
  SciTech Display Doctor 5.3a w/Disk & Manual 	   A$56.95    ___ $ ______

     Subtotal                                                     $ ______
     Shipping & Handling Charges                                  $ ______
        Australia:   Disk A$6.50     Disk and Manual A$10.00
        New Zealand: Disk A$8.50     Disk and Manual A$15.00

     Total Enclosed                                               $ ______

  I have read and agree to abide by the enclosed license agreement and I 
  agree to be bound by my credit card agreement. If shipping charges have 
  changed, I agree to pay the new charge.

      (Signature required) _____________________________________
Shipping charges are subject to change without notice