------------------------------------------------------------------------------ IMPORTANT - please check with ShareIt for current license fees. Registration form for TreeApplet Program No.: 101177 Option, please tick: . [ ] Single Web Page . [ ] Web server . [ ] Intranet server 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? 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 ___________________________ ------------------------------------------------------------------------------