Traverse PC Desktop – Student Edition

Complete this form and send to Traverse PC via Mail: P.O. Box 105, Florence, OR 97439 or Fax: (541) 201-2237

Failure to completely fill in the form may result in a delay or denial of your order.

Student: complete this section Instructor: complete this section
Name Name
Address Address
Address Address
City City
State/Province State/Province
Postal Code Postal Code
Country Country
Telephone Telephone
e-mail e-mail
Major Institution Name
Minor Course Name
I understand that this software is not transferable or upgradeable. I certify that I am a student in the course described above and that I am ordering this software to use in the course of my studies. I give my permission for Traverse PC to contact my instructor and me to verify these statements.Signature: _____________________________________Date: _____________________ I certify that I am the instructor of the course described above and that this person is a student in my class. I give my permission for Traverse PC to contact me to verify these statements.Signature: __________________________________________Date: _____________________