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| Order Form |
Date of Order: ___________________________
Purchaser's Name: _______________________________________________
Company Name: _______________________________________________
Address: _______________________________________________
_______________________________________________
Phone Number: ____________________________
Email Address: _______________________________________________
NetCharts IP Address(es): _______________________________________________
ChartExpress IP Address(es): _______________________________________________
Where did you hear about us: _______________________________________________
Quantity Unit Price SubTotal
Development Kit: ________ x $1,195.00 ____________
NetCharts Server License: ________ x $795.00 ____________
ChartExpress License: ________ x $495.00 ____________
SUB-TOTAL ____________
Yearly Subscription: add 50% ____________
TOTAL ____________
All products are distributed via the Internet. You will be sent, via email, the name of a Web server, an account name and a password when your order has been processed. Floppy disk distributions are also available for a $75.00 handling fee plus shipment charges. You may pay for your order using Visa, Mastercard, or American Express by providing us with the following information:
Card Number: ___________________________________ Exp. Date: _________NetFactory also accepts checks drawn on U.S. banks, money orders or international traveler's checks as payment. Corporate purchase orders can be used to initiate shipping as well.
| Please submit this form by faxing it to: | 301-625-5678 |
| Or by mailing it to: |
Sales Department NetFactory, Inc. 12510 Prosperity Dr. Suite 200 Silver Spring, MD 20904 |