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Text File  |  2000-06-19  |  2KB  |  42 lines
  1. Product Registration:  (MAR492-1, Wonders of Science)
  2.  
  3. Return this form to receive upgrades, discounts and new product information. Mail to: Arc Media Inc., 5330 Main Street #210, Buffalo, NY 14221-5360, fax to:  (416) 410-9651 or web site: www.arcmedia.com
  4.  
  5. Name: ______________________________________________________________
  6.  
  7. Age: ______________ Occupation: _______________________________________
  8.  
  9. Street: _____________________________________________________________
  10.  
  11. City: ___________________________________ State: ______________________
  12.  
  13. Country: ________________________ Zip/Postal Code: ______________________
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  15. Telephone: ___________________________ Fax: ___________________________
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  17. E-mail: _____________________________________________________________
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  19. Computer Type:    [  ] Macintosh    [  ] Windows 95    [  ] Windows 98    [  ] Windows NT
  20.  
  21. Please rate this product:    [  ] Excellent    [  ] Good    [  ] Poor
  22.  
  23. Comments: __________________________________________________________
  24.  
  25. ORDER FORM
  26.  
  27. Title Name                                                                                  Part #                Qty
  28.  
  29. 1 ______________________________________________    ___________    ___
  30.  
  31. 2 ______________________________________________    ___________    ___
  32.  
  33. 3 ______________________________________________    ___________    ___
  34.  
  35. Order paid by:    [  ] Check   [  ] Money order    [  ] MasterCard    [  ] Visa    [  ] Amex
  36.  
  37.     Credit Card #: ____________________ Name: ____________________________  
  38.  
  39.     Expiry date: ___________________ Signature: ___________________________
  40.  
  41. Please make check or money order payable to ARC MEDIA INC.
  42. [  ] Please send me a free catalog