GroupEase (tm) Order Form Please send me GroupEase: To place an order: Call (617) 393-5460 1 Your Name [______________________________] Fax (617) 393-5461 Telephone [______________________________] or Mail this form to: Ethosoft, Inc. 196 Boston Ave. Medford, MA. 02155 2 LICENSE TYPE GroupEase is sold on a per Server Units Nodes Price Total Price basis allowing 5, 10, 25, 50, +-------+-----+--------+-----------+ 100 and 250 nodes to access the | [ ] | 5 | $ 159 | [ ] | functionality. You can upgrade at | [ ] | 10 | $ 239 | [ ] | any time to increase the number of | [ ] | 25 | $ 419 | [ ] | simultaneous node connections. | [ ] | 50 | $ 649 | [ ] | | [ ] | 100 | $ 995 | [ ] | | [ ] | 250 | $ 1995 | [ ] | +-------+-----+--------+-----------+ Shipping Charges Subtotal: | [ ] | Ground: $ 6.00 Mass Residents | | 2 Day Air: $ 11.00 add 5% TAX: | [ ] | Overnight: $ 16.00 Shipping: | [ ] | COD Orders: add an additional $5.00 Order Total: | [ ] | Int'l Orders: Canada/Mexico add an additional +-----------+ $15.00. All others add an additional $30.00. 3 BILL TO Name: [____________________________________________] Company: [____________________________________________] Street: [____________________________________________] [____________________________________________] City: [____________________________________________] State, Zip: [____________________________________________] 4 SHIP TO (if different than above) Name: [____________________________________________] Company: [____________________________________________] Street: [____________________________________________] [____________________________________________] City: [____________________________________________] State, Zip: [____________________________________________] 5 PAYMENT We accept company purchase orders (credit subject to approval), VISA, MasterCard, American Express, COD, checks, and money orders (check one). P.O. # [_____________________________________] [_] VISA [_] MC [_] AmEx [_] Check [_] Money Order [_] COD Credit Card # [_________________________________________] Expiration [_____________] Signature [_________________________________________]