1st Clock Family License order form
===================================

Print this form (select "File|Print..."), and fill out all applicable 
fields below.

Fax this form to: 1-801-497-9456

Mail this form to: (checks payable to Emetrix)

Emetrix
ATTN: Sales
447 North 300 West Unit 2
Kaysville, UT 84037
USA

Name    _____________________________________________________

Address _____________________________________________________

        _____________________________________________________

City    _____________________________________________________

State   _____________________________________________________

ZipCode _____________________________________________________

Country _____________________________________________________

Phone   _____________________________________________________

Fax     _____________________________________________________

Email   _____________________________________________________

Credit Card Info: (if applicable)

 [ ] Visa [ ] MasterCard [ ] American Express [ ] Discover

Number  ___________________________________ Exp______________

Product Information:

Product Name    1st Clock Family License (Product ID: 136174433)

Quantity        _____________________________________________

Price per copy  _____________________________________________

 [ ] Add a CD-ROM ($9.95 per copy)

Total           _____________________________________________