INTENT OF USE STATEMENT
for
Magnetic Stripe Encoders / Portable Readers
The following information is requested for your initial purchase of Escan Technologies Corp.'s encoder / reader products:

I understand that by signing this statement, I am stating that the purchase of these products is not for illegal use.

Company Name:
 
Purchaser's First & Last Name:
 
Address:
 
City, State & Zip Code:
 
Telephone No.:
 

Signature
 
Title
 



Escan Technologies Corp.
800-653-4252 USA ** 951-270-1911 Int'l *** 951-304-1267 Fax
www.e-scan.com

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