EM Scientific, Inc.
2533 N. Carson Street, Suite 2107
Carson City, Nevada 89706
[$790.00 for less than 10, $553.00 for 10 or more]
Upgrade - Expert MININEC Broadcast Professional
Previous version serial numbers = _____________________
No.______ subtotal = _________________________________
[$150.00 for each upgrade from previous versions of Expert MININEC Broadcast Professional]
[$345.00 for each upgrade from previous versions of Expert MININEC Professional]
TOTAL = _______________ [Add $15.00 for wire service, if appropriate]
___ Payment enclosed of $________________ [U.S. dollars payable to EM Scientific, Inc.]
___ Purchase Order Number __________________
Date _____/_______/________
Telephone _______________
Company_________________________
Authorizing Agent _________________________
[Include billing address if different from shipping]
__________________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
Card No. ______________________________________
Name on Credit Card: ________________________
3 Digit Security Code:_________________________
[Last three digits on back of credit card]
Expires (date) ___________________________________
Telephone ______________________________________
Signature _____________________________________
Date _________________________________________
SHIPPING (Please print large or use large type for FAX):
[Check one] Best way ______ UPS_______ Airmail ______ Other ______
Address: __________________________________________________
__________________________________________________________
__________________________________________________________
__________________________________________________________
To receive an order response please include fax number or e-mail.
E-MAIL address:_________________________________________
Fax number:____________________________________________