Mail Order Form

Future MT Inc.
3208 E Colonial Drive #252
Orlando, FL 32803

MAIL ORDER FORM
Check, Money Order, or Credit Card

Fill out the appropriate fields below, then print this form (keep one for your records)
and send your payment with this printed form to:

NAME:
ADDRESS LINE 1:
ADDRESS LINE 2:
CITY:
STATE:
ZIP CODE:
EVENING PHONE:
EMAIL:
HOW DID YOU HEAR ABOUT US:
IF OTHER, PLEASE SPECIFY:
If you are going to pay with a Credit Card, Please complete below:
NAME ON CARD:
CREDIT CARD NUMBER:
VERIFICATION CODE:
EXPIRATION DATE:

Qty	Description	Price
1	Future MT Inc. - Medical Transcription Course	975.00
Delivery		17.87
	TOTAL FOR THIS ORDER	992.87

When you are finished, print this form and mail to the above address.

If you have any questions or to order by phone, call: 888-675-8615