ORDER FORM
TO REQUEST COPIES OF THE ESL PROGRAM, PLEASE FILL OUT THE FOLLOWING:
____________________________________________________________________________________

FIRST NAME:		
LAST NAME		
ORGANIZATION:		
TELEPHONE:		
FAX:		
E-MAIL:		
SHIPPING ADDRESS:	STREET / NO.:		
	CITY:		
	STATE / PROVINCE		
	COUNTRY:		
	POSTAL CODE		

HOW MANY COPIES DO YOU NEED?
	
FROM MASTER (BROADCAST) FORMAT:		
TO:

STANDARD FORMAT
(mark applicable):

DUPLICATION FORMAT
(mark applicable):	NTSC:
	X	USA, Canada, Japan	
	PAL:
	X	UK, Germany, Israel...	
	SECAM:
	X	France	
	MESECAM:
	X	Greece, Egypt, Iran...	
	PAL N
	X	Argentina	
		
	BETACAM SP:	X	
	DIGITAL BETACAM:	X	
	DV CAM:	X	
	DVC PRO:	X	
	HI - 8:	X	
	8 mm:	X	
	S-VHS:	X	
	VHS:	X	
	OTHER (specify):
		
REQUIRED BY:
(standard delivery, according to most US/Canadian delivery services):	
24 to 72 Hours	3 to 5 Days	5 to 7 Days	more than 7 Days	
X	X	X	X	
- 2 -

HOW DID YOU HEAR ABOUT US?
(mark applicable)	SEARCH ENGINE	WEB SITE LINK	OTHER
(specify)	
	X	X		

SEND THE FORM TO:

			ROMCAN INC.				Telephone / Fax: +(403) 244 - 2256
			5, 1823 - 26 Avenue, S.W.		E-mail: consulting@nucleus.com
			Calgary, AB., T2T 1E2
			Canada

MAKE CHECK OR MONEY ORDER PAYABLE TO ROMCAN INC.  MAKE SURE YOUR CHECK OR MONEY ORDER CLEARS IN A CANADIAN BANK.  YOUR BANK MAY PROVIDE YOU SUCH INFO.