<!-- Standard inclusions for all payment screens. -->

<Input type=hidden name=form_url		value="http://www.compusource.co.za/$register">
<Input type=hidden name=form_fields	value="config:/Version,*">
<Input type=hidden name=form_encode	value=x-pw>
<Input type=hidden name=form_format	value=arglist>

<!-- Initial screen. -->

<Input type=hidden name=Product		value="<!--#echo var=Product		-->">
<Input type=hidden name=Platform		value="<!--#echo var=Platform		-->">
<Input type=hidden name=Method		value="<!--#echo var=Method		-->">
<Input type=hidden name=EMail			value="<!--#echo var=EMail			-->">
<Input type=hidden name=Host			value="<!--#echo var=Host			-->">
<Input type=hidden name=IPAddress	value="<!--#echo var=IPAddress	-->">
<Input type=hidden name=ServerIP		value="<!--#echo var=ServerIP		-->">
<Input type=hidden name=ServerPort	value="<!--#echo var=ServerPort	-->">
<Input type=hidden name=Referal		value="<!--#echo var=Referal		-->">
<Input type=hidden name=Referer		value="<!--#echo var=Referer		-->">
<Input type=hidden name=ListKeep		value="<!--#echo var=ListKeep		-->">
<Input type=hidden name=ListRemove	value="<!--#echo var=ListRemove	-->">

<!-- Personal Details screen. -->

<Input type=hidden name=FirstName	value="<!--#echo var=FirstName	-->">
<Input type=hidden name=LastName		value="<!--#echo var=LastName		-->">
<Input type=hidden name=TelCountry	value="<!--#echo var=TelCountry	-->">
<Input type=hidden name=TelArea		value="<!--#echo var=TelArea		-->">
<Input type=hidden name=Company		value="<!--#echo var=Company		-->">
<Input type=hidden name=DayPhone		value="<!--#echo var=DayPhone		-->">
<Input type=hidden name=NightPhone	value="<!--#echo var=NightPhone	-->">
<Input type=hidden name=Addr1			value="<!--#echo var=Addr1			-->">
<Input type=hidden name=Addr2			value="<!--#echo var=Addr2			-->">
<Input type=hidden name=Fax			value="<!--#echo var=Fax			-->">
<Input type=hidden name=TimeZone		value="<!--#echo var=TimeZone		-->">
<Input type=hidden name=City			value="<!--#echo var=City			-->">
<Input type=hidden name=Zip			value="<!--#echo var=Zip			-->">
<Input type=hidden name=State			value="<!--#echo var=State			-->">
<Input type=hidden name=Country		value="<!--#echo var=Country		-->">

<Input Type=hidden Name=BuyServer Value=1>

<img src=/icons/bullets/green.gif width=10 height=10>
<a href=pricing.htm><b>Pricing Details<b></a>
<blockquote>
			PowerWeb Server++ is charged per copy loaded in memory.
	<br>	Each copy of PowerWeb Server++ must be licensed individually.
</blockquote>

<img src=/icons/bullets/green.gif width=10 height=10>
<b>License Type:</b><p>
	<Select Name=LicenseCategory>
		<Option selected>Single Copy
		<Option>Educational
		<Option>User Group Member
		<Option>User Group
		<Option>Early Adopter 1.9
		<Option>5 Copies
		<Option>10 Copies
		<Option>20 Copies
		<Option>30 Copies
		<Option>40 Copies
		<Option>50 Copies
		<Option>75 Copies
		<Option>100 Copies
	</Select>

<p>
<table border=0>
<tr>
	<td valign=top>
		<Input Type=radio Name=BuySupport Value=1 checked>Yes
		<Input Type=radio Name=BuySupport Value=0>No
	<td>
	<td><b>Would you like to include support?</b>
	<br>The Annual Support Fee is charged per server.
	<p>

</table>

