SciTech Software 
		       Replacement Code Request Form

SciTech Software, Inc.  					  
180 East 4th Street, Suite 300 
Chico, CA 95928 USA
		         		          ___/___/___
PLEASE PRINT CLEARLY OR TYPE!			   MM/DD/YY

Name:___________________________________________________________

Company:________________________________________________________

Product & Version____________________  Purchase Date____________

Invoice Number________________ OR  Order Id Number i-___________

Current Address & Contact Information
	
   Address :____________________________________________________

   City: ____________________________ State:____________________

   Zip/Postal Code: _________________  Country: ________________

   Phone: _____________________  Email:_________________________

Address At Time of Purchase (if different)

   Address :____________________________________________________

   City: ____________________________ State:____________________

   Zip/Postal Code: _________________  Country: ________________

   Phone: _____________________  Email:_________________________


Email this form to support@scitechsoft.com for an email response.

*Please note: If you wish to receive a printed response via postal 
mail, you will need to mail the completed form with a self addressed, 
postage paid envelope.  Please allow 2-4 weeks for delivery.

Thank you,

SciTech Software Inc.