Gameport Secure Ordering Form
This form is for ordering by mail.
Please complete and print this form and send it together with a check to the address below:
MS Electronics - Gameport
10661 Rene St.
Lenexa, KS 66215
Product Description
Product:
Net Metal Registration
Platform:
PCGames
Price:
US $24.00 includes for UPS shipping
Personal Information
First Name:
Middle Initial:
Last Name:
Street Address:
Apt/Suite #:
City:
State (U.S. only):
[Choose one -- United States ONLY]
Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
District of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri
Montana
Nebraska
Nevada
New Hampshire
New Jersey
New Mexico
New York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming
---
American Samoa
Canal Zone
Federated Staes of Micronesia
Guam
Marshall Islands
Northern Mariana Islands
Palau
Puerto Rico
Trust Territory
U.S. Virgin Islands
---
Armed Forces Africa
Armed Forces Americas
Armed Forces Canada
Armed Forces Europe
Armed Forces Middle East
Armed Forces Pacific
Province (Canada only):
[Choose one -- Canada ONLY]
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland
Newfoundland (Labrador)
Northwest Territories
Nova Scotia
Ontario
Prince Edward Island
Quebec
Sakskatchewan
Yukon
Country:
[select]
United States (48 States)
United States (Alaska/Hawaii)
CANADA
UNITED KINGDOM
AUSTRALIA
NEW ZEALAND
JAPAN
SWEDEN
BELGIUM
NETHERLANDS
NORWAY
GERMANY
FRANCE (Incl. MONACO)
SINGAPORE
AFGHANISTAN
ALBANIA
ALGERIA
ANDORRA
ANGOLA
ANGUILLA
ANTIGUA
ARGENTINA
ARMENIA
ARUBA
AUSTRALIA
AUSTRIA
AZERBAIJAN
AZORES
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BARBUDA
BELARUS
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BOSNIA - HERZEGOVINA
BOTSWANA
BRAZIL
BRITISH VIRGIN ISLANDS
BRUNEI DARUSSALAM
BULGARIA
BURKINA FASO
BURMA
BURUNDI
CAMEROON
CAPE VERDE
CAYMAN ISLANDS
CENTRAL AFRICAN REPUBLIC
CHAD
CHILE
CHINA
COLOMBIA
COMOROS
CONGO
CORSICA
COSTA RICA
COTE d'IVOIRE (IVORY COAST)
CROATIA
CYPRUS
CZECH REPUBLIC
DENMARK
DJIBOUTI
DOMINICA
DOMINICAN REPUBLIC
ECUADOR
EGYPT
EL SALVADOR
EQUATORIAL GUINEA
ERITREA
ESTONIA
ETHIOPIA
FALKLAND ISLANDS
FAROE ISLANDS
FIJI
FINLAND
FRENCH GUIANA
FRENCH POLYNESIA
GABON
GAMBIA
GEORGIA, REPUBLIC OF
GHANA
GIBRALTAR
GREECE
GREENLAND
GRENADA
GUADELOUPE
GUATEMALA
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HONDURAS
HONG KONG
HUNGARY
ICELAND
INDIA
INDONESIA
IRAN
IRAQ
IRELAND
ISRAEL
ITALY
JAMAICA
JORDAN
KAZAKHSTAN
KENYA
KIRIBATI
KOREA, DEM. PEOPLE'S REP. (North)
KOREA, REPUBLIC OF (South)
KUWAIT
KYRGYZSTAN
LAOS
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACAO
MACEDONIA, REPUBLIC OF
MADAGASCAR
MADEIRA ISLANDS
MALAWI
MALAYSIA
MALDIVES
MALI
MALTA
MARTINIQUE
MAURITANIA
MAURITIUS
MEXICO
MOLDOVA
MONTSERRAT
MOROCCO
MOZAMBIQUE
NAMIBIA
NAURA
NEPAL
NETHERLANDS ANTILLES
NEVIS
NEW CALEDONIA
NICARAGUA
NIGER
NIGERIA
NORTHERN IRELAND
OMAN
PAKISTAN
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
PITCAIRN ISLAND
POLAND
PORTUGAL
QATAR
REUNION
ROMANIA
RUSSIA
RWANDA
SAINT CHRISTOPER (ST. KITS)
SAINT HELENA
SAINT LUCIA
SAINT PIERRE and MIQUELON
SAN MARINO
SAINT VINCENT and the GRENADINES
SAUDI ARABIA
SENEGAL
SERBIA-MONTENEGRO (YUGOSLAVIA)
SEYCHELLES
SIERRA LEONE
SLOVAK REPUBLIC
SLOVENIA
SOLOMAN ISLANDS
SOMALIA
SOUTH AFRICA
SPAIN
SRI LANKA
SUDAN
SURINAME
SWAZILAND
SWITZERLAND
SYRIA
TAIWAN
TAJIKISTAN
TANZANIA
THAILAND
TOGO
TONGA
TRINIDAD AND TOBAGO
TRISTAN DA CUNHA
TUNISIA
TURKEY
TURKS and CAICOS ISLANDS
TURKMENISTAN
TUVALU
UGANDA
UKRAINE
UNITED ARAB EMIRATES
URUGUAY
UZBEKISTAN
VANUATU
VATICAN CITY
VENEZUELA
VIETNAM
WESTERN SAMOA
WALLIS and FUTUNA ISLANDS
YEMEN
ZAIRE
ZAMBIA
ZIMBABWE
Zip/Postal Code:
Work Phone:
US and Canada xxx-xxx-xxxx
Home Phone:
US and Canada xxx-xxx-xxxx
E-mail Address:
Register Software
Upon credit card approval, your credit card will be charged the amount of US $24.00, and your order will be processed and details of this purchase will be sent promptly to the E-mail address above.
Please make sure that your E-mail address is correct,
otherwise your activation code will not reach you!
If for some reason you lose your activation code, please contact us.
Gameport
© 2004-2009
Metropolis
, Inc.
For questions or comments email:
[email protected]
.