Registration form for Middle Mouse Button 1.9.2

Name:
Organization:
Address Line 1:
Address Line 2:
City:
State or Province
Postal code:
Country:
Phone:
Fax:
Email:

Registration options:

Single user registration and diskette $10.00 + $5.00 shipping,
Number of copies of Mbutton on diskette required:________
Select desired disk format....   3.5"____ or  5.25"____

Single user registration 	$10.00.		Qty: ______
Five user registration 		$30.00.		Qty: ______
Ten user registration   	$50.00.		Qty: ______
Fifty user registration 	$200.00.	Qty: ______
100 user registration 		$350.00.	Qty: ______
500+ user registration 		$1500.00	Qty: ______

Payment methods:
If paying by check or money order, payment should be in US funds.
Checks should also be drawn on a US or Canadian bank.
Make the check or money order payable to: Digital Control Systems.

We will also accept American Express, MasterCard or  VISA.
___ Check here to charge to your American Express account.
___ Check here to charge to your MasterCard account.
___ Check here to charge to your VISA account.

Name (as it appears on card):
Card Number:
Exp date:
Signature (if mailed or faxed):

If paying by credit card:
Use the secure on-line transaction server on our website, or if you prefer;
You may fax this form to 1-615-413-5089.
You may send this form to this email address :  mbutton@digconsys.com
You may also call us at: 1-615-216-6007 or 1-877-253-8089.
Or you may use our Postal mailing address (required for check or money order):

Digital Control Systems
1315 East Castle St. #D3
Murfreesboro, TN 37130-4545
USA