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Rental Program Registration
Please complete the form if you would like to receive information on The Network’s New Rental Program when it is available in October 2002.

Fields marked with an * are required.

Customer Number: (if known)
*Your Name:
Your Title:
*Company Name:
*Email address:
*Telephone Number:
*Fax Number:
*Address1:
Address2:
*City:
*State/Province:
*Zip/Postal Code:
Country:
Number of videos used per year:		Top three most needed video topics: 1. 2. 3.
Rental period desired:		2 weeks 4 weeks 6 weeks Other, please specify