		Registration Form

NRich (tm)

NRich WebColor 
version1 


Date (MM/DD/YY): __/__/__

1. Information: please complete/include all that's applicable

Name: ___________________________________________________________
Address:_________________________________________________________
City: ___________________________________________________________ 
Prov / State: __________________ (2 letter abbreviation prefered)
Postal Code /ZIP: ___________
Country (if other than Canada / US): ____________________________
Phone number: (___)______________ 
E-mail address (if applicable):__________________________________


2. Payment and fees:

Fees are in U.S. dollars for all, 
except for 
Canadian residents, who can pay in Canadian funds.
Canadian residents add appropriate sales tax. 

Please do not send cash. 
Checks and money orders only.

Checks and money orders must be made payable to:
David J.Toms 

Select form of payment (check one):
__ Enclosed check or money order in Canadian dollars
__ Enclosed check or money order in U.S. dollars


3. Pricing for the use of NRich WebColor per site computer 

__ 1st computer at $5:................................ = $ 5.00
__ 2nd or greater at $3 each:............... ____ x  3 = $______
__ Canadians add appropriate sales tax.................. $______

    Total:.............................................. $______

4. Mail this form together with payment to:

	David J. Toms
	NRich WebColor
	P.O. Box 237
	Bishop's Falls, NF
	CANADA
	A0H 1C0



	NOTE: 	make sure you make payment out to: 
		David J. Toms
