Mail and fax order form

When the below form is submitted, a new page will be generated containing the information supplied already completed. You can then print and mail or fax the form along with payment to purchase Blaze MediaConvert.

Billing Address Information

	First Name
	Last Name
	Address Line 1
	Address Line 2
	City
	State / Province
	ZIP / Post Code
	Country
	Phone
	E-mail

Product ID

The Product ID can be located by running the trial version of Blaze MediaConvert, clicking the "Help" menu, and selecting the "Purchase" option. The Product ID will be listed in the lower-left corner of the resulting window. If your trial period has expired, this window will display automatically when attempting to access the program. Product ID

Payment Information

Select Payment Type:

	Personal or business check. It usually takes 2 to 5 business days after receipt of the check for the bank to process the check. Once the check has been processed the activation code will be e-mailed to you within 48 hours. (Attention: There will be a $25.00 USD charge for all returned checks)
	Cashiers Check or Money Order
	Credit Card (Please ensure the information above matches the address on record with your credit card provider.)

Credit Card Information

(No credit card details are stored or used during this operation. The below information is required only if ordering by credit card.)

Name on Credit Card

Card Number

Expiration Date

Month Year

Signature

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