LeapFTP v2.X			LeapWare
    License Order Form               	P.O. Box 155340
                                     	Fort Worth, TX 76155
				     	Fax: 281-754-4650
				     	E-mail: sales@leapware.com
 

    Name: __________________________________________________________

    Company: _______________________________________________________

    Address: _______________________________________________________

    City: ________________________________  State: _________________

    Zip/Postal Code: _________________    Country: _________________

    Phone: __________________________  Fax: ________________________

    Email: _________________________________________________________


    Register software to:    [ ] Name     [ ] Company

    Payment Method:

        [ ] Check            [ ] Money Order
	
	[ ] Credit Card:     _____________________________  
 
                    Exp:     _____ / _____
      
           Name on Card:     _____________________________ 

	[ ] Purchase Order:  __________________


    Number of Licenses:      ________

    Total Cost:              ________