Institution: _______________________________________________________________
Address: _________________________________________________________________
City: ____________________________________________________________________
State/Country: ____________________________________ Zip: ____________________
Subscription contact:* _____________________________________________________
Email: ___________________________________________________________________
Phone: _____________________________
Fax: __________________________
Adminstration contact:*
___________________________________________________
Email:
___________________________________________________________________
Billing requirements: Purchase order: [
] Invoice: [ ]
Payment Type: Check: [ ] Bank transfer: [ ] Credit card (surcharge): [ ]
|
|
Qty |
Price each |
Total |
|
|
|
$ |
|
|
Updates and Support (first 12 months) |
|
FREE |
FREE |
|
Updates and Support (Additional 12 months) |
|
$ |
$ |
|
Sales Tax ( |
|
$ |
$ |
|
TOTAL |
|
|
$ |
Tax exemption # (if Florida-based): _
Bibliographic Utility (e.g.,
OCLC, ITS, etc.):
Local System (e.g., Dynix, ITS, Winnebago, etc.):
Library Type: Academic [ ] Public [ ] School [ ] Special [ ] Other:
Please sign here: Date of order:
Thank you for your order
The
3830 S. Highway A1A, #4-167,
Voice/FAX: 321-676-1904 Email Address
* Subscription contacts
receive invoices or quotes when the annual subscriptions for the software are
due
* Administration contacts
receive notification of updates. If you are ordering multiple copies of the
software and wish each user to receive notifications, send names and emails of
each user.