Print this form, fill in the blanks using block letters and send it with
your check to:

    Avral Technologies Ltd,
    10 Marlene Street, Casebrook, 
    Christchurch 8005, 
    New Zealand

AVRAL TECHNOLOGIES LIMITED
URLCHOPPER ORDER FORM FOR PAYMENT BY CHECK

* Use this form only if you wish to pay by check. For other
payment options please refer to
http://avral.com/uc/uc-register.php

* Make the check payable to Avral Technologies Limited.

* We prefer payments in US dollars. However you are welcome to
pay in another currency. Please use a currency converter such as
http://www.xe.net/ucc/ to calculate the payment amount.

* We will not abuse your personal information. For details,
please refer to http://avral.com/privacy.php

* If you wish to discuss volume discounts or site licensing
options, please send an email to sales@avral.com before you pay.

LICENSING AND PAYMENT DETAILS (all fields are required):

  URLchopper single-user license: ___ @ US$  9.95 = US$ ______

  URLchopper 5 user license:      ___ @ US$ 29.95 = US$ ______
    
                                      Total: US$ _____________

  Note: If you are paying in a currency other than US dollars, 
  please use a currency converter such as http://www.xe.net/ucc/
  to calculate the payment amount and then fill in the following
  two fields:
  
  Total: _______  The currency used:___________________________

  Please make the check payable to Avral Technologies Limited.
  
USER DETAILS:
  In whose name is the software to be registered (required field):

  ______________________________________________________________

  Country (required field):_____________________________________

  Contact email (required field, please check spelling): 

  ______________________________________________________________
 
  Address : ____________________________________________________

  ______________________________________________________________

  Telephone: ______________________ Fax: _______________________

     Signature (required field):  ___________________________

           Date(required field):  ___________________________

Please send this form and your check to:
        Avral Technologies Ltd,
        10 Marlene Street, Casebrook, 
        Christchurch 8005, 
        New Zealand

When the payment is received, we will email the registration
codes to you. This email will also serve as confirmation of
payment (receipt) and will contain the instructions for
completing the registration process. Please check your email
address before sending this form!

Thank you for owning URLchopper!