                        WORKPLACE SECURITY ORDER FORM 
 
 Mail Order to:

 Maple Valley Software                   Fax:       (612) 493-5485
 10875 Maple Valley Drive                E-mail:    mvsoft@ibm.net
 Maple Grove,  MN  55369                
 USA

 
 Name           _____________________________________________________

 Company Name   _____________________________________________________

 Street Address _____________________________________________________

 City           _____________________________________________________

 State/Country  ___________  Zip/Postal Code __________-_____________

 Phone Number   (     ) ___________________


 o Form of Payment. 

    - __ Check/Money Order      __ Purchase Order (enclose P.O.) 


 MAKE PAYMENT PAYABLE TO: Maple Valley Software 

 
 Date of Order:  ___________________


 Quantity:       ___________________ @ $25.00 USD single user 
                                     

 Total Amount:  $___________________



 Language: German version______ English version ______
 


 To receive the registration code electronically,
 specify a Compuserve/Internet/America Online address


 _____________________________________________
 

 If you downloaded your copy of Workplace Security, which 
 Internet site, online service or BBS did you find it on?



 ______________________________________________



Note: If Faxing this order via a fax-modem that does not
support fax calling tones (beeps every 3 seconds), append
the sequence ,#11,#11,#11,#11 at the end of the phone number
to directly access our Fax machine dialing port.

Example: 1 612 493-5485,#11,#11,#11,#11  

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