Name: __________________________________________________________
Title: ____________________________________________________________
Company Name: __________________________________________________
Address (1): ______________________________________________________
Address (2): ______________________________________________________
Telephone: _______________________________________________________
E-mail : __________________________________________________________
Purchase Date: ____________________________________________________
Where did you purchased the product?
____ Mail order
____ Reseller/VAR
____ Retail Store
____ Internet
Reseller Name: ___________________________________________________
Reseller Address __________________________________________________
Telephone: _______________________________________________________
Fax: _____________________________________________________________
What PC will this TECOM product be used?
____ Desktop PC
____ Notebook PC
Where will the product primarily be used?
____ Home
____ Office
____ Personal Use
** PLEASE ATTACH A PHOTOCOPY OF RECIPET OF ORIGINAL PURCHASE! **
