INIPATcher Registration and Order Form CAFIP1.0 ___________________________________________________ To place your order, fax us at (504) 626-1189 or send this form to: DAMEWARE DEVELOPMENT 1024 Live Oak Loop Mandeville, La. 70448 For credit orders see section: Credit card order information Name: ________________________________________________________ Company Name: ________________________________________________________ Address: ________________________________________________________ ________________________________________________________ ________________________________________________________ ________________________________________________________ Phone: Day time:_______________________Eve:______________________ Electronic Mail: _________________________ INIPATcher _____@ $10.00 ea $________________________ Shipping and Handling $ 3.00 $________________________ INIPATcher Site License 2 to 5 computers: _____ computers @ $10 each = ______________ 6 to 10 computers: _____ computers @ $9 each = ______________ 11 to 49 computers: _____ computers @ $6 each = ______________ 50 to 99 computers: _____ computers @ $5 each = ______________ 100 to 199 computers: _____ computers @ $3 each = ______________ (More than 199 copies are negotiable) Total $________________________ Please specify disk format: 5 1/4"_____ 3 1/2"_____ PLEASE NOTE: We accept cash, checks, money orders and COD's except international. We do not accept unsolicited POs or overseas checks not drawn on American banks. Overseas orders please include an additional $5.00 USD for S & H. CAFIP1.0