## Registration For xReminder Pro | ### Product ID: 30391
Option 1 : Order by Mail - 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 Rd Suite 220 Duluth, GA 30097
Option 2 : Order by Fax - Fill in the form below, print it out, and FAX it to: 770-497-9234.
Option 3 : Order by Voice: 1-877-REGSOFT (1-877-734-7638); 1-770-497-9126 (international orders). Please include the below Product ID as well as any required fields below.
Option 4 : Order Online - 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 | $ 16.95
10 | 24 | $ 14.95
25 | 49 | $ 12.95
50 | 99 | $ 9.95
100 | Unlimited | $ 7.95
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.