PC Door Guard (product number 2304-1): order form
==================================================================

Mail this form to:	Register Now!
			Dept# 1170-35
			PO Box 1816
			Issaquah, WA 98027
			United States of America

Or fax it to:		1 888 353-7276 (U.S. and Canada; toll-free)
			1 425 392-0223 (other countries; regular)

Or just call: 		1 877 353-7297 (U.S. and Canada; toll-free)
			1 425 392-2294 (other countries; regular)


Check, money order, purchase order or credit card order accepted
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~
Note: for mailed orders, the checks need to be made out to "Register
Now!". For international checks, we would prefer the funds be drawn in
US dollars. When this is not possible, we will accept checks for a
corresponding amount in the country's currency. Unfortunately,
Eurochecks are not accepted. A purchase order must be faxed or mailed
to the address listed above with all necessary information including
billing information.



Order Information
~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~~

Unit                                     Price/Unit   Quantity   Total
----------------------------------------------------------------------

PC Door Guard            (2304-1)       $29.95       ________   _____


Payment Information
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First Name:      _____________________________________________________

Last Name:       _____________________________________________________

Company:         _____________________________________________________

Street Address:  _____________________________________________________

                 _____________________________________________________

City:            _____________________________________________________

State/Province:  _____________________________________________________

Zip/Postal Code: _____________________________________________________

Country:         _____________________________________________________

Daytime Phone:   _____________________________________________________

Fax:             _____________________________________________________

Email Address:   _____________________________________________________

Payment:         __ MasterCard     __ VISA     __ AMEX     __ Discover
                 __ Check       __ Money order       __ Purchase order


For credit card orders:

Name on Card: ________________________________________________________

Credit Card Number: __________________________________________________  

Expiration Date: month _______________ year (4 digits) _______________


                Signature : ____________________  Date: ______________