SleepMultiMedia^ä version 6.51 - Upgrade Request

  Please print this form, complete and fax for an upgrade of SleepMultiMedia

Upgrades are only available to registered owners of SleepMultiMedia.  

 

 

INSTITUTIONAL Upgrade Price - $225 + S&H

 

  (To ensure accuracy, please print all information) 

 

 

Name:_________________________________________Title: Ms/ Mr/ Dr/ DDS/RPSGT/ RRT

Department:  __________________________________________________________________

Institution:  ____________________________________________________________________

Address:  ______________________________________________________________________

City, State, Zip  _________________________________________________________________

Phone:____________________________________ Fax: ________________________________

E-mail:________________________________________________________________________

Serial Number (on DVD-ROM): ________________________________________

Payment: So that we may ship your order immediately, please select one of the following:

Shipping (Federal Express): USA $15, Other $35.

·       Payment enclosed (Make check payable to Sleep Multimedia, Inc.)

·       Charge to: MasterCard / VISA / AmEx

  

Cardholder's Name:_____________________________________________         

Card Number:____________________________________________________    

Expiration Date:_____­­­___            Signature:____________________________   

Cost: __________  Shipping: ______  NY State Tax: ________  TOTAL:  _______ 

    

  If delivery is in New York, add local Sales Tax (if exempt, please attach certificate)

TERMS: Payment is due in full at the time of the order. No COD's will be accepted.  

 

  Sleep Multimedia, Inc.

P.O. Box 329-H, Scarsdale, NY 10583, U.S.A.

Tel:  914 722-9291   Fax:  914 722-4490