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  1. Product Registration: MMT621-1, Image Source vol. 10: Kids
  2.  
  3. Return this form to receive upgrades, discounts and new product information. Mail to: 
  4. Arc Media Inc., 5330 Main Street #210, Buffalo, NY 14221-5360, fax to: (416) 410-9651 
  5. or register on our web site: www.arcmedia.com
  6.  
  7. Name: _______________________________________________________________________________
  8.  
  9. Age: ____________  Occupation: ______________________________________________________
  10.  
  11. Street:  ____________________________________________________________________________
  12.  
  13. City: ____________________________________________  State: __________________________
  14.  
  15. Country: _________________________________  ZIP/Postal Code: ________________________
  16.  
  17. Telephone: ___________________________  Fax: ________________________________________
  18.  
  19. E-mail: _____________________________________________________________________________
  20.  
  21. Platform:    [  ] Macintosh   [  ] Windows 3.1   [  ] Windows 95   [  ] Windows 98
  22.  
  23.              [  ] Windows NT
  24.  
  25. Please rate this product:    [  ] Excellent    [  ] Good    [  ] Poor
  26.  
  27. Comments: ___________________________________________________________________________
  28.  
  29. _____________________________________________________________________________________
  30.  
  31. _____________________________________________________________________________________
  32.  
  33. ORDER FORM:
  34.  
  35. Title Name                         Part #            Qty
  36.  
  37. 1________________________________________________    ___________________    _________
  38.  
  39. 2________________________________________________    ___________________    _________
  40.  
  41. 3________________________________________________    ___________________    _________
  42.  
  43. Order Paid by: [ ] Check  [ ] Money Order  [ ] MasterCard  [ ] Visa   [ ] Amex
  44.  
  45.     Credit Card #: _______________________  Name: _______________________________
  46.     
  47.     Expiry Date: _____________________  Signature: ______________________________
  48.  
  49. Please make check or money order payable to ARC MEDIA INC.
  50.  
  51. [ ] Please send me a free catalog
  52.