ExpressBrowser Registration
Request Form - Postal/Fax
First name: _____________________________________
Last Name: _____________________________________
Email Address: __________________________________
Program Serial No.: ______________________________
(to find the serial number press the 'ADD LINK' button
located on any browser tab. The program serial number
will be available at the bottom of the screen).
Mailing address:__________________________________
_________________________________________________
Phone Number:____- ____________ State: ___________
Zip: ______________________ Country: ______________
Select method of payment
[ ] Pay by Credit Card
[ ] Visa [ ]
Mastercard
Total amount to be paid :____AU$28.00___( US$14.95 ) ___
Card Number: ____________________________________
Name on card: ___________________________________
Card Expiry date: _________________________________
Signature: _______________________________________
[ ] Pay by Cheque or money order
Make cheque/money order payable to Click2.com Pty Ltd
Total amount to be paid: ______AU$28.00____( US$14.95 )_____
--------------------------------------------------------------------------------------
Our mailing
address
Click2.com Pty Ltd 16 Larch St.
Caulfield 3162,
Melbourne VIC, Australia.
Fax
number
61- 3- 95285781 (if dialing from outside Australia)
03 - 95285781 (within Australia)
<< Back
to online registration