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Registration Information (required):
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| Buyer
Name: |
________________________________________________
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| Number
of Copies: |
________________________________________________ |
| Buyer
Phone Number: |
________________________________________________ |
| Buyer
Fax Number: |
________________________________________________ |
| Buyer
e-mail: |
________________________________________________ |
| Company
Name: |
________________________________________________ |
| Company
Address: |
________________________________________________ |
|
________________________________________________ |
|
|
City
|
State
|
Postal
Code
|
Country
|
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Send or fax this form along with your purchase order to:
ControlNet International, Ltd. 2370 East Staduium Boulevard
#1005 - Ann Arbor, MI 48104-4811 - Fax: (1) 734-922-0027. Be
sure to include complete Sold To, Ship To, and Invoice To addresses
(if different) along with Test Order Form and Purchase Order.
Companies
will be invoiced upon completion of the test. Payable upon receipt,
or Payable via VISA, MASTERCARD, or AMERICAN EXPRESS. Complete
the following for credit card purchases.
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| Card
Number: |
Name
as it appears on the card: |
| Expiration
Date: |
Signature: |
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