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| <HTML> | |
| <HEAD> | |
| <META NAME="GENERATOR" CONTENT="Adobe PageMill 3.0 Mac"> | |
| <TITLE>Product Registration</TITLE> | |
| </HEAD> | |
| <BODY BGCOLOR="#ffffff"> | |
| <FORM METHOD="POST" ACTION="mailto:info@microconnectors.com" | |
| ENCTYPE="text/plain"> | |
| <H2><CENTER><TABLE WIDTH="450" BORDER="1" CELLSPACING="2" CELLPADDING="0"> | |
| <TR> | |
| <TD COLSPAN="3"> | |
| <P><CENTER> <FONT FACE="Arial,Helvetica"><IMG SRC="RevMicroLogo.jpg" | |
| WIDTH="100" HEIGHT="49" ALIGN="BOTTOM" BORDER="0" NATURALSIZEFLAG="3"></FONT></CENTER></TD> | |
| </TR> | |
| <TR> | |
| <TD COLSPAN="3"> | |
| <H2><CENTER><FONT FACE="Arial,Helvetica">Product Registration</FONT></CENTER></H2> | |
| <P><CENTER><FONT FACE="Arial,Helvetica">Thank you for purchasing | |
| a Micro Connectors Product. This form will ensure that you receive | |
| notification of all software/hardware updates for the period | |
| of one year from date of purchase</FONT></CENTER></P> | |
| <P><CENTER><B><FONT FACE="Arial,Helvetica">Name/Company</FONT></B><FONT | |
| FACE="Arial,Helvetica"> <INPUT TYPE="text" NAME="text_1" SIZE="20"></FONT></CENTER></P> | |
| <P><CENTER><B><FONT FACE="Arial,Helvetica">Address:</FONT></B><FONT | |
| FACE="Arial,Helvetica"> <INPUT TYPE="text" NAME="text_2" SIZE="28"></FONT></CENTER></P> | |
| <P><CENTER><B><FONT FACE="Arial,Helvetica">City/State/ZipCode</FONT></B><FONT | |
| FACE="Arial,Helvetica"><INPUT TYPE="text" NAME="text_2" SIZE="20"></FONT></CENTER></P> | |
| <P><CENTER><B><FONT FACE="Arial,Helvetica">Model Number</FONT></B><FONT | |
| FACE="Arial,Helvetica"> <INPUT TYPE="text" NAME="text_3" SIZE="20"></FONT></CENTER></P> | |
| <P><CENTER><B><FONT FACE="Arial,Helvetica">Serial Number</FONT></B><FONT | |
| FACE="Arial,Helvetica"> <INPUT TYPE="text" NAME="text_4" SIZE="20"></FONT></CENTER></P> | |
| <P><CENTER><B><FONT FACE="Arial,Helvetica">Date Purchased</FONT></B><FONT | |
| FACE="Arial,Helvetica"> <INPUT TYPE="text" NAME="text_5" SIZE="20"></FONT></CENTER></P> | |
| <P><CENTER><B><FONT FACE="Arial,Helvetica">Dealer Name/URL</FONT></B><FONT | |
| FACE="Arial,Helvetica"> <INPUT TYPE="text" NAME="text_6" SIZE="20"></FONT></CENTER></P> | |
| <P><CENTER><B><FONT FACE="Arial,Helvetica">How did you hear about | |
| this Micro Connectors Product?</FONT></B><FONT FACE="Arial,Helvetica"> | |
| <BR> | |
| <TEXTAREA NAME="text_area" ROWS="6" COLS="44" | |
| ></TEXTAREA></FONT></CENTER></P> | |
| <P><CENTER><FONT FACE="Arial,Helvetica"> <INPUT | |
| TYPE="reset" NAME="Reset" VALUE="Reset"> <INPUT TYPE="submit" | |
| NAME="Submit" VALUE="Submit"></FONT></CENTER> | |
| </TD> | |
| </TR> | |
| <TR> | |
| <TD WIDTH="33%"> </TD> | |
| <TD WIDTH="33%"> | |
| <P><CENTER> <FONT SIZE="-1" FACE="Arial,Helvetica">Webmaster: | |
| info@microconnectors.com</FONT></CENTER></TD> | |
| <TD WIDTH="34%"> </TD> | |
| </TR> | |
| </TABLE></CENTER></H2> | |
| </FORM> | |
| </BODY> | |
| </HTML> |