PolyImagePro/PolyImagePro64 Registration Order Form =================================================== Name: ____________________________________________________________ Address: ____________________________________________________________ Address: ____________________________________________________________ City/State/Zip: ____________________________________________________________ Email: ____________________________________________________________ (Instructions on how to access the licensed version of the PolyImagePro library will be sent directly to your specified email address) _____ PolyImagePro Licenses at $399.95 US each _________ _____ PolyImagePro64 Licenses at $399.95 US each _________ Total _________ Print this form, fill it out, and mail along with a check or money order to: Polybytes, Inc. 3427 Bever Avenue SE Cedar Rapids, IA 52403-3161 USA Please make registration checks payable to Polybytes, Inc. Customers outside the USA: Please send a check for your payment in US dollars on a US bank, or in your country’s currency drawn on a bank in your country. In the latter case, please apply the current exchange rates to calculate the amount necessary to equal the purchase price in US dollars. Iowa Residents: Add 5% Iowa sales tax to purchase amount.