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MinIdent-Win Mail-in Purchase Conversion Form
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Thank you for your interest in MinIdent-Win. Please complete this form in
capitals. It will constitute your purchase order.

Name of purchaser (the "licensee")______________________________________
Address of purchaser:___________________________________________________
________________________________________________________________________
________________________________________________________________________
Phone number of purchaser_______________________________________________
Fax number of purchaser_________________________________________________
Email address of purchaser______________________________________________

Address for delivery if different from above:___________________________
________________________________________________________________________
________________________________________________________________________

Name of end-user if different from purchaser:___________________________
Phone number of end-user________________________________________________
Fax number of end-user__________________________________________________
Email address of end-user_______________________________________________

I have previously purchased a copy of the Student Edition of MinIdent-Win.
Please upgrade this to:
The full Professional edition † @ US$200                   _____________
The Collector's edition ‡ @ US$50                          _____________
Packing & shipping already paid
Canadian residents add GST (at 7%)							           _____________
Grand Total										                             _____________

*Note that each copy of MinIdent-Win is licensed for installation on one
(1) computer platform only and bears a unique product code that is needed
for successful installation and the required registration.

†  The full Professional edition carries on on-going license, is
upgradable and includes unnamed minerals. It has a 30-day grace period for
registration.

‡  The Collector's edition carries an on-going license, is upgradable but
does not include unnamed minerals. It has a 30-day grace period for
registration.

Payment in full in United States dollar funds is attached in the form of
(check one):
  [ ] International Money order
  [ ] Western Union Money transfer
  [ ] Certified cheque drawn on any Canadian Bank or Trust Company
  [ ] Please send us information on where to wire payment

For companies with established credit only:
Please supply against our purchase order number:
_________________________________________________________________________

Please note: that the product cannot be registered and fully
activated until payment has cleared our bank

Please send your completed order to:
Micronex®, 4356 - 148 Street, Edmonton, Alberta, Canada, T6H 5V5

_________________________
(Dated)

_________________________________________________________________________
(Name and signature of Person requesting the quotation)

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For Micronex® Use-please do not write in this area