Crazy Rides Registration Form

Please print this page then enter the following information for registration.

Name: _______________________________________________
Company: _______________________________________________
Address: _______________________________________________
_______________________________________________
City: _______________________________________________
State: _______________________________________________
Country: _______________________________________________
Zip Code: _______________________________________________
Phone: _______________________________________________
FAX: _______________________________________________
E-mail: _______________________________________________


Registration choice:

Product Item
Number		 Price
(US$)		 Qty Total
Wheel Maker License 1555-1 19.95 ____ _________
Bicycle Gear Calculator License 1555-2 19.95 ____ _________
Bicycle Software Package License 1555-3 29.95 ____ _________
Wheel Maker Online 
(One year subscription)		 1555-6 9.95 ____ _________
Bicycle Gear Calculator Online 
(One year subscription)		 1555-7 9.95 ____ _________
Racer Log Online 
(One year subscription)		 1555-8 9.95 ____ _________

TOTAL Registration FEE(s)
_________


Payment Method:

Check: ___ payable to Register Now!
(Mail orders only)
or
Credit Card: VISA __ MASTERCARD __ DISCOVER __ AMEX __
Card Number: _________________________________________
Expiry Date: _________________________________________
Name on card: _________________________________________
Billing address: _________________________________________


Comments:

_____________________________________________________________
_____________________________________________________________
_____________________________________________________________

(10/99)