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  1.                Registration Form for Insert Printer™
  2.  
  3.                    (Please print this form, and fill it out by hand)
  4.  
  5. Name: ____________________________________________________________
  6.  
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  8. Address: __________________________________________________________
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  11. City: _____________________________ State: _______ Zip Code: __________
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  14. Country (if outside of U.S.): __________________________________________
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  17. Telephone Number: _________________________________________________
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  20. E-mail (optional): __________________________________________________
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  24.          Please send $10 (U.S.) check or money order and this form to:
  25.  
  26.                                                Studio B
  27.                                         1018 Central Ave.
  28.                                       Charlotte, NC  28204