REGISTRATION FORM FOR (CCI)

COOPER CONTROL INTERFACE PROGRAM

Please return this registration form upon receipt of this package. By

returning this form, you become a registered user of the Cooper Control
Interface Program. This information will allow Cooper Power Systems the
opportunity to keep you current with the latest information and software
updates to the program as they are developed.

Return this form to:

Cooper Power Systems
Kyle Distribution Switchgear
Attention: Matt Watkins
P.O. Box 800
2800 9th Avenue
South Milwaukee, WI 53172-0800

You can also FAX the form to Matt Watkins at (414) 768-8334 or email to
Mwatkins@cooperpower.com with your information. (Please do not use this email
for technical questions.)

Name / Title: ________________________________________________________________

Company Name: ________________________________________________________________
Address: _____________________________________________________________________
City / State: ________________________________________________________________
Province / Country: __________________________________________________________
ZIP / Postal Code: ___________________________________________________________

Telephone Number: ______________________________

FAX Number: __________________________________
Email Address: _________________________________

Software Version Number: _________________________________________

Software Key-Code: ______________________________________________

Equipment used to run the program (circle):

CL4 / CL5
DATAREADER
FORM 4C
ALL

Optional Information:
CPS Sales Representative: ________________________________________________

KA2048-473 Rev. 2
99013