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    REHABTOOL.COM - FreeSearch(TM) - ORDER FORM
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 1. Complete this order form and send it to us by 
    email, fax, or postal mail.

    Email:   FreeSearch@rehabtool.com
    Fax:     (1) 281-531-6406
    Address: RehabTool.com
             P.O. Box 572190
             Houston, TX 77257
             USA


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1. WHAT ARE YOU LOOKING FOR?
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Describe your needs, requirements, whishes, 
constraints, barriers, etc.



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2. DESCRIBE THE DISABILITY, IMPAIRMENT, OR CONDITION
   OF THE PERSON NEEDING THE TECHNOLOGY OR PRODUCT
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3. WHAT TASKS SHOULD THE TECHNOLOGY OR PRODUCT HELP
   ACCOMPLISH OR PERFORM?
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4. DESCRIBE THE ENVIRONMENT IN WHICH THE TECHNOLOGY
   OR PRODUCT WILL BE USED
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5. TELL US ABOUT YOURSELF
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Your Full Name:

Your Email Address:

Your Phone Number:

Your Home/Work Address:


Would you like to receive our FREE quarterly
Assistive Technology newsletter? [Y/N]


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NEED ASSISTANCE OR HAVE A QUESTION?
===================================================

Don't hesitate to contact us! Our dedicated team is
available to answer your questions. For questions about
searches, contact search@rehabtool.com. For ordering
or payment questions, contact sales@rehabtool.com.

For more information about our Product Search & Referral
services, visit us at http://www.rehabtool.com and 
choose "Find a Product".

Thank you for ordering our services. We look forward to
helping you find the best technology for your needs.