Mail Order Form

Future Medical Transcriptionist Inc.
3208-C E Colonial Dr #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 795.00

Please select the correct foot pedal compatible with your computer.

This 15-pin foot pedal connects to a 15-pin game port (also called a MIDI port) on your PC. The Foot Pedal is REQUIRED to operate the CD-ROM's voice files. 0.00

14.87

TOTAL FOR THIS ORDER 809.87

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