TR CD-ROM/DVD Application

If you are a registered DTIC® user and you wish to subscribe to the TR Database on CD-ROM/DVD product you may use this form.

If you are not a DTIC-registered user, you may request the DTIC Registration Packet by completing this form, or call 1-800-225-3842 (menu 2, option 2), 703-767-8273, DSN 427-8273.

Part I - Organizational Information: To be completed by the official responsible for authorizing the use and payment of information services. This authorization will pertain to individual users of this application.
	CD-ROM    DVD
DTIC User Code:
Organization Name:
Address:
City:
State:
ZIP:
Payment Method (if applicable):	Customer assumes risk when submitting Credit Card information via email. As an alternative, this form can be returned to DTIC by fax or regular mail. If information is not provided, DTIC will call the customer.
	VISA    American Express    MasterCard
Credit Card Number:
Credit Card Exp Date:

Part II - Individual User Information
Individual Name:
Title:
Address:
City:
State:
ZIP:
Commercial Phone Number:
DSN Number:
Email Address:

Part III - So we can better serve you...
Which of the following marketing activities would you consider most influential in leading you to subscribe to the service?	Not Sure STINET Information on the Homepage News Release on the Homepage News Release via mail DTIC Digest DTIC Demo Day ListServ message Presentation/Meeting with DTIC staff Training Word of mouth (Other than DTIC staff) Dial-up DROLS account discontinued Other (Please explain below)
Other:

Mail:

Defense Technical Information Center
DTIC-BC (Registration)
8725 John J. Kingman Road
Ft. Belvoir, VA 22060-6218

October 2004
bcporder@dtic.mil