BABY & CHILD GROWTH MONITOR 2.0 ORDER FORM AND REGISTRATION

If you like the free version (1.0), please order version 2.0 which can record and chart up to 240 measurement dates from birth to 20 years. All versions require Excel 97 for Windows or higher. Please contact us if you require an Excel 95 version. All software is provided subject to our License Agreement. Payments must be in US dollars drawn on a US bank, or send an international postal money order in US dollars. 

					Please Enter Quantity 
Shipping Destination	 License	Next To Desired Format
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within the USA		Individual	___CD $11 each
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outside the USA		Individual	___CD $15 each
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For larger quantities, please contact us to order a Site License.

Please select one of the following payment methods:

___Paying securely by PayPal: PayPal is a fast, free and secure way to send money. Complete this form, copy it into an email message and email it to us at runwell@mail.com. Then go to www.paypal.com and send your payment to: runwell@mail.com. PayPal offers you $5 just for signing up.

___Paying by check or money order: Print this form. Mail the completed form with your check/money order payable to Runwell, Inc. to:  Runwell, Inc., P.O. Box 252, Tenafly, NJ 07670, USA.

Please enter your billing address and the shipping address if different:

Billing Address (*=required)
First Name*:
Last Name*:
Company:
Street Line 1*:
Street Line 2:
City*:
State/Province*:
ZIP/Postal Code*:
Country*:
E-mail*:
Tel:
FAX:

Shipping Address
First Name:
Last Name:
Street Line 1:
Street Line 2:
City:
State/Province:
ZIP/Postal Code:
Country:
Gift message (if sending as a gift):

I am a: ___Parent
	___Physician
	___Other:____________________

How did you hear about this product? 

Thank you for your order!

Runwell, Inc.
P.O. Box 252
Tenafly, NJ 07670
USA

Payments: runwell@mail.com, 
Contact: info@babygrowthmonitor.com or info@childgrowthmonitor.com
Web Site: www.babygrowthmonitor.com or www.childgrowthmonitor.com