Program Registration of Buddy Saver

To: ShareIt! Inc.
P.O. Box 844
Greensburg PA 15601-0844
U.S.A.

Fax: (724) 850-8187
Phone: 1-800-903-4152

This is an order for the Buddy Saver by Gary Smith. The program number is 102339.

Last name:
First name:
Company:
Street and street #:
City and postal code:
Country:
Phone:
Fax:
E-Mail: (Your registration code will be supplied by email)
Please enter your E-mail address again for confirmation:
I will pay the registration fee of US $125 by:
Credit card information (if applicable):
NOTE: Please be advised that ShareIt! prosecutes intentional
credit card fraud to the fullest extent of the law.
Credit card number:
Valid until (mm/yy): /
Name of card holder:
Address of cardholder if different from above:
Street and street #:
City and postal code:
Country:

I understand that a registration code will be provided by e-mail.

 

Signed:

Date: