## Registration For xReminder Pro | ### Product ID: 30391
Option 1 : Postal Mail Ordering - Fill in the form below, print it out, and Mail it along with a Check or Money Order, payable in US Dollars to : RegSoft.com, Inc. PMB 201 10820 Abbotts Bridge Road, Suite 220 Duluth, Georgia, USA 30097
Option 2 : FAX Ordering - Fill in the form below, print it out, and FAX it to: 1-800-886-6030 ( US & Canada Toll-Free Fax Orders ) 1-208-279-3837 ( International Fax Orders ) (0870)132-2485 ( United Kingdom Fax Orders )
Option 3 : Phone Ordering Click here for details
Option 4 : On-Line Ordering - Go to secure online order page.
### Product Information:
Product ID: | 30391
Program Name: | xReminder Pro
Units From | Up to | Price Per Unit
--- | --- | ---
1 | 1 | $ 19.95
2 | 9 | $ 17.95
10 | 24 | $ 15.95
25 | 49 | $ 12.95
50 | 99 | $ 9.95
Quantity (Units): |
Total payment: |

### Billing Information:
Email Address: user@domain.com |
Full Name: as it appears on the credit card |
Company Name: (optional) |
Address: exactly as it appears on your credit card statements |
Address (cont): |
City: |
State/Province: |
Country: |
Zip/Postal Code: |
Phone Number: |
Fax: |
Please be sure your email address is correct! This is how you will receive your registration confirmation. HOTMAIL email addresses, and other email forwarding addresses are NOT accepted

### Credit Card Details:
Select type of credit card: |
Card Number: |
Expiration Date: |
Signature: | __________________________________
Date: | __________________________________
By signing, you agree to pay the above indicated fees, billed by RegSoft.com Inc. to your credit card account, for this order.