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  1.  
  2. CO-MOTION® REGISTRATION AND ORDER FORM
  3.  
  4. NAME
  5.   __________________________________________________
  6. ADDRESS
  7.   __________________________________________________
  8.   __________________________________________________
  9.   __________________________________________________
  10.   __________________________________________________
  11. PHONE
  12.   __________________________________________________
  13.  
  14. ORDERING INFORMATION
  15. Single-machine license for Co-motion
  16.                                                                         $  30 US
  17. Additional single-machine licenses
  18.                                                                         $_____
  19. Shipping and handling
  20.                                                                         $  10 US
  21.                                                TOTAL DUE
  22.                                                                         $_____
  23.  
  24. PAYMENT
  25.   __  Check/Money Order — Make payable to Bittco Solutions
  26.   __  Visa/MasterCard — Fill in the information below
  27.  
  28.       Credit Card Number _______________________________
  29.       Expiration Date _________
  30.       Card Holder’s Name _______________________________
  31.       Signature _______________________________________
  32.  
  33. MAIL THIS FORM TO –
  34.         Co-motion c/o Bittco Solutions
  35.         #26, 52510 Rge. Rd. 213
  36.         Ardrossan, AB
  37.         Canada, T8G 2E6
  38.  
  39. OR FAX THIS FORM FOR IMMEDIATE PROCESSING TO -
  40.         (403) 922-2859
  41.  
  42. OR EVEN EASIER, ORDER BY TELEPHONE AT -
  43.         (403) 922-5514
  44.  
  45. OR YOU CAN REACH US EMAIL AT --
  46.         sales@bittco.com
  47.