Order Form to Obtain a Registered License for the
                   POSC Universal Units Converter

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NAME & ADDRESS

First Name:	_________________________

Last Name:	_________________________

Street Address:	_________________________

		_________________________

City:		_________________________

State/Province:	_______________  Postal Code:  __________

Country:	_________________________

Email:		_________________________

Phone:		___________  Fax:  ___________


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QUANTITY OF LICENSES ORDERED

Number of licenses:  __________

  @ $10.00 US ea.    $_________

  if in Texas add
  sales tax of 8.25% $_________

  Total remitted:    $_________


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METHOD OF PAYMENT

  _____ Check in US dollars drawn on a US bank (enclosed)

  _____ Credit Card

    Name on Card ____________________

    Card Number  ____________________ Expiration Date _________________

    Card Type  Visa ___  Mastercard ___  Amex ___

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Email, fax or mail the above order form to:

POSC - Attn: Accounting     Fax: (713) 784-9219
Suite 450                   Email: orders@posc.org
9801 Westheimer
Houston, TX 77042
USA