SleepMultiMedia 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.

    PERSONAL Upgrade Price - $195 +  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