---------------------------------------------------------------- Registration Form/Invoice For BaseNow Professional Edition Program No.: 160510 ---------------------------------------------------------------- ____ copies at $399 each = ______ Last name: ___________________________________ First name: ____________________________________ Company: ____________________________________ Street and #: ______________________________________ City, State, Postal Code: ________________________________ Country: _______________________________________ Phone: _____________________________________ Fax: ________________________________________ E-Mail: ______________________________________ How would you like to pay the registration fee of $399: Credit Card - Wire Transfer - EuroCheque - Cash Credit card information (if applicable) Credit card: Visa - Eurocard/Mastercard American Express - Diners Club Card holder: ________________________________ Card No.: ___________________________________ Date of Expiration : ___________________________________ Date / Signature ___________________________ ----------------------------------------------------------------