INTENT OF USE STATEMENT
for
Magnetic Stripe Encoders / Portable Readers



The following information is requested for your initial purchase of Incode Corp.'s encoder / reader products:

I understanding 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
 




Due to the nature of the equipment being purchased, this information may be subpoenaed by the legal authorities.











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