Application Form

Put your cat on the Web for 3 months free!

This is not an online registration form!
Please print this form by selecting print frame
from your browser options
and mail it to us.

All information is required for registration. All information will be kept confidential, and will be used exclusively by Cat Scans. We do not sell our mailing list to other parties.     To register more than one cat, please make a copy of this form and use one form per cat.    Thank you.
Your Name ______________________________________________________
Your Mailing Address ______________________________________________________
State and ZIP CODE ______________________________________________________
Daytime  Telephone
        Number
(____________)_________________________________________
E-mail Address ______________________________________________________
How many cats do you own?   ________________    (Please register only one cat per form, below.)
Cat's Name _______________________________________________________
Cat's Sex _____ Male    _____ Female
Is your cat still on one of it’s 9 lives, or has it passed on and deserves a loving tribute? _____ Living   _____ Deceased, but missed and very loved!

If deceased, YEAR cat died _____________.
Cat's Birthdate
(month & year)		 _____ Month            _____ Year 
Is birthday exact or approximate? _____ Exact     _____ Approximate
Was cat a stray, or rescued from a shelter? _____ No      _____ Yes, stray _____ Yes, shelter
Is cat a registered breed? _____ No      _____ Yes
Breed/Color/Markings _____________________________________
Do you have an existing Web site (family site or your own cat site) that you want linked to your Cat Scans site? Provide URL below.

http://__________________________________________________________________________
On the back of this form, please tell us about your cat.
(This is the information that will appear on your cat's Web site.)  Some ideas: How you met your cat.
Some amusing "hobbies" your cat has. Your cat's favorite toys.  Heroic acts, etc.

If you have something already compiled on computer disk, we can accept text in ASCII format,
or as a Word Perfect or Microsoft Word IBM compatible document. Diskettes can be mailed with
this application form, or files can be e-mailed to us as attachments to catscans@tconl.com
(be sure to specify that your application form is being mailed, and give us your NAME in your e-mail).
You may also submit poems, short stories, etc.
To introduce you to Cat Scans, your cat’s bio and photo will be shown on the Cat Scans
Web site for 3 months free!    Or, if you want your tribute on the Web for a year, you can
pay the $15 yearly registration fee now, and your page will be shown for a total of 15 months
(3 free months, and 12 months of paid time).

_____ 3-month Trial Only (Please notify me when the trial is up,to give me the opportunity
to continue the registration.)

_____ I am enclosing $15 for a one-year registration. This covers 15 months
(12 paid months and 3 free months). I understand you will notify me when my registration
expires, to give me the option to continue the registration.
Your registration includes one photo of your cat posted to your Web site. You may post additional photos at an additional cost of $5 per photo.

Please indicate the number of photos enclosed with this registration in the appropriate blank at the right.		 I am enclosing _________ photographs of my pet.

_____ Actual photographs.
_____ Computer disk with .bmp, .jpg or .gif files.
_____ Files have been e-mailed to you.

I have added an extra __________ ($5 per photo over one) to my payment.

We accept actual photographs, or .bmp, .jpg or .gif files submitted
on IBM compatible computer diskette, or by e-mail to
catscans@tconl.com     (Photos and disks cannot be returned unless
you enclose a self-addressed, stamped envelope with sufficient postage.) 

We accept payment by money order or personal check (no credit cards) to:


Cat Scans
PO Box 390011
Omaha, NE 68139-0011

Payment Summary

_____ Free trial only, no payment enclosed.

_____ Free trial and one-year registration fee, $15 enclosed.

_____ Free trial and one-year registration fee, plus ______ additional
           pictures (over one) at $5 each.

TOTAL PAYMENT ENCLOSED: ____________

I have provided all information and any photographs and/or computer files for use by Cat Scans.
These items may be used on the Cat Scans Web site (your mailing address will not be printed)
and may be used in Cat Scans advertisements, merchandising, etc. My signature, or any payment made
to Cat Scans gives my consent to this agreement.

SIGNATURE REQUIRED: __________________________________Date _____________________

Cat Scans, P.O. Box 390011, Omaha  NE 68139-0011