SUBMISSION FORM—TEXT VERSION

IMPORTANT: Have your kit or component seen by hundreds of potential buyers each day! Simply let us know what you have for sale, filling in this form and printing it out and faxing it to us or mailing it to us along with 1 or more photos of what you are selling. Please provide all the requested information, confirming accuracy before sending.

To submit listing by mail, send to:

VORTECH, Inc.
P O BOX 511 - W
Fallston, MD 21047 • USA

Important: Items with asterisk (*) must be filled in. Personal information will not be published unless requested.

Your e-mail address: _____________________________________________

*Your Name: ______________________________________________________

*Address:_________________________________________________________

*City: ________________________________________________________

*State / Province: _____________ *Zip / Postal Code: ___________________

*Country (if not USA) ___________________________________________

*Phone: ___________________________  Fax: __________________________

Please list the below item(s) on the Vortech Hot Specials page.

I have available (provide full description and, where appropriate, include brand/manufacturer/model, year of manufacture, color, degree of completeness, etc.): ______________________________
______________________________________________________________________
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Condition of item(s) (include an accurate description of physical condition of whatever you are selling, including age or date of manufacture, physical/mechanical defects, any damage, history of accidents, amount of rust or corrosion, if any, etc.):
_________________________________________________________________________________
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Asking price (if you are selling more than one item, list price for each separately; also, include minimum acceptable price):

1. ________________________________________________________

2. ________________________________________________________

3. ________________________________________________________

Amount for Crating Item(s): $ _______________

Amount for Shipping Item(s), if this is prepaid: $ ___________

Please note: there is no charge for listing an item sold through Vortech. However, if you wish to sell an item on your own, using your own address & phone number, the price per listing is only $29.95 per month or $320 per year, plus a one-time** setup cost of $25 (**an additional $15 is charged for each subsequent modification of your listing). For commercial advertisements, the cost is $49.95 per month or $530 per year (initial setup charge is also $25 if the ad is already prepared or a charge will be quoted if you wish us to set up your ad). Your listing includes a brief description of what you are selling along with a photo of the item—and, if you have a separate presence on the web, a hot link to your site. Payment may be mailed to Vortech (address below) or may be charged to your credit card (fill in below). Photos should be mailed directly to Vortech.

CARD TYPE (check one)  ____VISA    ____ MASTERCARD    ____AMEX    ____ DISCOVER

CARD NUMBER: ________________________________________________

EXPIRATION DATE: (in the form mm/yy; such as, 08/27): ___________________________

3-DIGIT SECURITY CODE (CVV) ___________________

NAME APPEARING ON CARD: _______________________________________________

SIGNATURE OF CARD HOLDER:: _____________________________________________

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