APPLICATION TO MEDIA SCIENCES, INC. FOR INFORMATION REGARDING THE CERTIFICATION LISTING PROGRAM FOR INTERCHANGEABLE COMPUTER MEDIA

The below referenced company ("Applicant") hereby applies for the Program Manual of the CERTIFICATION LISTING PROGRAM FOR INTERCHANGEABLE MEDIA of Media Sciences, Inc.    (Please print clearly.)

Company Name (Applicant):

Address:

Contact Person:                                                                         Phone Number:

In order to process this application a fee of U.S.$50.00 payable to "Media Sciences" Inc." (company check, bank order, or cashier's check in U.S. currency only) must be submitted with this application. Sorry, no credit cards or personal checks. Do not send cash.

Has fee been enclosed?           ____ Yes          ____ No

1. Description of Services and Application Process

Media Sciences, Inc. provides a CERTIFICATION LISTING PROGRAM FOR INTERCHANGEABLE COMPUTER MEDIA. Manufacturers' facility registration to ISO 9002 and product qualification to the relevant ISO product Standard are verified. Qualifying products and facilities are then placed on a CERTIFIED PRODUCTS LIST that is available to all interested parties.

Once your application for information about the Certification Service has been received and reviewed, you will receive a PROGRAM MANUAL for the CERTIFICATION LISTING PROGRAM FOR INTERCHANGEABLE COMPUTER MEDIA. Should you wish to request certification, you will submit an APPLICATION and SERVICES AGREEMENT at which time you will be asked to submit a $500.00 application fee.

2. No Representation of Economic Benefit

Media Sciences, Inc. makes no representations of economic benefit as a result of any application leading to Certification.

3. Confidential and Proprietary Information

The Applicant acknowledges and agrees that any and all information Applicant has requested and will receive concerning the CERTIFICATION LISTING PROGRAM FOR INTERCHANGEABLE COMPUTER MEDIA is "Confidential and Proprietary Information," and agrees that it will be used only for the purpose of participation in the program as a manufacturer or user. The Applicant agrees that it will not otherwise permit the duplication, use or disclosure of any such Confidential and Proprietary Information to any person by the Applicant unless specifically authorized in writing by Media Sciences, Inc.

ACCEPTANCE OF TERMS AND CONDITIONS OF THIS APPLICATION

As an authorized representative of the above named Applicant, I hereby agree to and accept all terms and conditions outlined in this application including but not limited to the conditions regarding Confidentiality.

Signature of Applicant's Representative:                                                         Title of Representative:

MAIL WITH PAYMENT TO:
Media Sciences, Inc.
P.O. Box 2258
Plainville, MA 02762
U.S.A.
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