eCard Maker Order Form
-------------------------------------- 

WEB Version 1.05  $14.99 

-------------------------------------- 
NAME:
EMAIL:
STREET ADDRESS:
STATE/PROV:
COUNTRY:

COMPANY:

-------------------------------------- 
IF PAYING BY VISA PLEASE INCLUDE YOUR
VISA NUMBER:

xxxx xxxx xxxx xxxx 

DATE OF EXPIRY ON CARD
mm/yy 

NAME ON CARD:

-------------------------------------- 
We will send you the registration codes.

--------------------------------------  
Print and mail this Order Form to: 
eMaker Registration 
eMedia Communications Ltd. 
231 22nd Ave NW 
Calgary, Alberta, CANADA 
T2M 1N2 
-------------------------------------- 