Order Form

Print this form out, complete, and mail to this address:

KTMS Datasets
c/o K. Takki Media Services
48 Allston Street
Allston, MA 02134-5001

Phone: (617) 254-7969
Fax: (617) 254-3525
E-mail: ktakki@artcrime.con

Please enclose a check or money order made payable to "K. Takki Media Services", US funds only. Allow 4-6 weeks for delivery. Shipping charges are included within the Continental US only.

     Name ___________________________________________________

     Company ________________________________________________

     Title __________________________________________________

     Address 1 ______________________________________________

     Address 2 ______________________________________________

     City ____________________ State/Province _______________

     Zip/Postal Code ________________ Country _______________

     Phone ______________________ Fax _______________________


Item # ________ Name _____________________ Price ____________

Item # ________ Name _____________________ Price ____________

Item # ________ Name _____________________ Price ____________

Item # ________ Name _____________________ Price ____________

Item # ________ Name _____________________ Price ____________

Item # ________ Name _____________________ Price ____________

Item # ________ Name _____________________ Price ____________

                                        Subtotal ____________

Massachusetts Residents: please add 5% sales tax ____________

                                           Total ____________