Please complete the form below and choose File|Print from your browser menu. Mail your completed order form to MD Computer Consultants at P.O. Box 3203 Culver City, CA 90231, or fax it to us at (310) 390-9865.

Contact Information


Name:    
Company: Email:
Address: Phone:
City: Fax:
State: Zip: Country:

Product & Purchase Information Information


Where did you purchase your product?
 Directly from MDCC   Purchased from reseller:

Please fill in the dates of purchase and return, and pricing information
Purchase date: Return date:
Purchase price: Shipping cost:

Reason for Return


Please indicate why you want to return this product, so we can make our products better in the future. Your comments are greatly appreciated.

Agreement


This is a legal agreement between you (either an individual or an entity) and MDCC Corporation ("MDCC").
1.You agree to immediately destroy all copies of the software and its serial numbers.
2.You confirm athat you have not distributed any of the redistributable components, as described in section 7 of the license agreement.

Customer signature: Date: