****** FlexTouch Mail Order Form - Payment By Check ******

Please make sure that the check is made out to "Register Now!". 
Unfortunately, Eurochecks are not accepted. You may also order FlexTouch
online via SECURE order form:

https://www.regnow.com/softsell/nph-softsell.cgi?item=2888-1

Please fill out and print this form, then mail it to:

Register Now!
Dept# 2888-1
PO Box 1816
Issaquah, WA 98027
United States of America

To have your order processed successfully, please fill out this form as 
completely as possible. 

Thank you for registering FlexTouch!

*** FlexTouch Order Form begins ***

Product ID: 2888-1

First Name: ________________________________________________________

Last Name: _________________________________________________________

Company: ___________________________________________________________

Billing Address: ___________________________________________________

____________________________________________________________________
  
City: ______________________________________________________________

State/Province: ____________________________________________________

Zip/Postal Code: ___________________________________________________

Country: ___________________________________________________________
  
Phone: _____________________________________________________________

Email Address (REQUIRED): __________________________________________
 
Quantity ($19.95 each): ____

*** FlexTouch Order Form end ***