Max-Scribe Order Request Form
Please check your system
requirements
first.
Name
Organization
Daytime Phone
(including area code)
Email
Prefered contact method
Phone
Email
Street Address
City
Province/State
Alberta
British Columbia
Manitoba
New Brunswick
Newfoundland and Labrador
Nova Scotia
Northwest Territories
Nunavut
Ontario
Prince Edward Island
Quebec
Saskatchewan
Yukon
Alabama
Arkansas
Arizona
California
Colorado
Connecticut
District Of Columbia
Delaware
Florida
Georgia
Iowa
Idaho
Illinois
Indiana
Kansas
Kentucky
Louisiana
Massachusetts
Maryland
Maine
Michigan
Minnesota
Missouri
Mississippi
Montana
North Carolina
North Dakota
Nebraska
New Hampshire
New Jersey
New Mexico
Nevada
New York
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Virginia
Vermont
Washington
Wisconsin
West Virginia
Wyoming
Postal Code/
Zip Code
Country
Australia
Belgium
Bermuda
Canada
Denmark
Finland
France
Germany
Greece
Ireland
Israel
Italy
Japan
Mexico
New Zealand
Norway
South Africa
Sweden
Switzerland
United Kingdom
United States
Comments
Max-Kit
Max-Scribe Transcription Software
(Single License)
Serial Foot Pedal
Head Set with Microphone
Description
Qty
Unit
Extended
Max-Scribe Transcription Software
(Single License)
145.00
0.00
Max-Scribe Transcription Software
(Volume License 5 or more)
125.00
0.00
Serial Foot Pedal
135.00
0.00
USB Foot Pedal
145.00
0.00
Head Set
35.00
0.00
Head Set with Microphone
45.00
0.00
Portable MP3 Recorder / Player
95.00
0.00
Max-Kit
295.00
0.00
Max-Kit Plus
385.00
0.00
Sub-Total
0.00
Shipping and Handling
10.00
GST
0.00
Total
$0.00
Max-Kit Plus
Max-Scribe Transcription Software
(Single License)
Serial Foot Pedal
Head Set with Microphone
Portable MP3 Recorder / Player