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Company Name:_____________________________________________ Personal Name:____________________________________________ Mailing Address:__________________________________________ City:___________________________________ State:__________________________________ ZIP:_________________ Shipping Address (if different):___________________________________________ City:___________________________________ State:__________________________________ ZIP:____________________________________ Telephone:______________________________ Fax:____________________________________ Email address:__________________________ Modern Medium WebSite User ID:__________ Please send me the following products: (Prices are in USD) -------------------------------------------------Price(each)-----Quantity------Total Blocks & Materials 2, Imperial Units (inches):____$299______________________________ Blocks & Materials 2, Metric Units (millimeters):_$299______________________________ Blocks & Materials 2, for AccuRender 3:___________$299_____________________ Just Textures:____________________________________$99________________________________ Just Textures for Ray Dream:______________________$99________________________________ Shipping (select one): U.S.- Ground:_____________________________________$10________________________________ U.S. - 2 day Air:_________________________________$15________________________________ U.S. - Next Day:__________________________________$25________________________________ Canada:___________________________________________$35________________________________ International Express:____________________________$75________________________________ ------------------------------------------------------------------------Total:______ Payment method Credit Card Type: Visa, MasterCard, Amex (select one) Credit card number:__________________________________ Expiration date:__________ Name on credit card (if different):______________________________ Signature________________________________ Comments:____________________________________________________________________________ _____________________________________________________________________________________ _____________________________________________________________________________________