Order form for web access to: seedimages.com

Colorado State University
Department of Soil and Crop Sciences
Plant Sciences Building
Fort Collins, CO 80523-1170

Carissa Schow
Telephone: 970-491-6295
FAX: 970-491-0564
cschow@lamar.colostate.edu

Date: __________________________________

BUSINESS/COMPANY REGISTRATION:
Username and Password sharing is strictly prohibited. Companies with multiple office locations are required to purchase a subscription for each location. Please use a separate order form for each location.

Company/Organization: ___________________________________________________
Contact Person: __________________________________________________________
Address: _______________________________________________________________
________________________________________________________________________
________________________________________________________________________
Home Telephone: _________________________________________________________
Work Telephone: __________________________________________________________

STUDENT REGISTRATION:
Name of Educational Institution: _____________________________________________
Coursework/Area of Study: ________________________________________________
Name: _________________________________________________________________
Address: _______________________________________________________________
________________________________________________________________________
________________________________________________________________________
Home Telephone: _________________________________________________________

ORDER INFORMATION FOR ANNUAL SUBSCRIPTIONS:

**Email: __________________________________________________________________
**The email digits prior to the "@" symbol will be the assigned username**

Password: 1. ____________________ 2. ____________________ 3. ____________________
**Please make a 1st, 2nd, and 3rd choice. Verification of username and password will be via email or phone**

Locations with greater than 100 Employees--$150.00/subscription/year
Locations with 50-100 Employees--$100.00/subscription/year
Locations with less than 50 Employees--$75.00/subscription/year
Student Rate--$25.00

Number of subscriptions for this location _________ at $_________ per subscription.
**Please use an additional page to list email and password choices for multiples subscriptions for this location. Thank You**

Total Amount Due $_____________

Please make check payable to: Colorado State University

Credit Card Information:

Card type: ________________________ Card Number: ___________________________________

Exp. Date: ________________________ Signature (required): ______________________________