****************** Avensoft Order Form ***************************** Your Name ...... : ------------------------------------------------- Your Company ... : ------------------------------------------------- Phone Number ... : ------------------------------------------------- Fax Number ..... : ------------------------------------------------- Email Address .. : ------------------------------------------------- ( ) Pay by Credit Card. Please fax this form to +1 888 476 6276. *************** Also send an email to sales5@avensoft.com so that we can contact you in case your fax is not readable. Credit Card : ( ) AMEX ( ) MasterCard ( ) VISA Card Number : ------------------------------------------------- Security Code: ------------------------------------------------- Exp. Date : ------------------------------------------------- Name On Card : ------------------------------------------------- Billing : Address ------------------------------------------------- ------------------------------------------------- ------------------------------------------------- Signature : ------------------------------------------------- ( ) Pay by checks drawn on U.S. banks, international traveler's checks or money orders. Please mail this form with payment to: Avensoft, Inc. 1249 S. Diamond Bar Blvd, Suite #25 Diamond Bar, CA 91765 United States ( ) Pay by Fund Transfer. E-mail this form to sales5@avensoft.com. -------------------------------------------------------------------- Product UnitPrice Quantity Total -------------------------------------------------------------------- nService Software Subscription US$ 60/year/tech x = -------------------------------------------------------------------- nService Perpetual License US$ 300/tech x = -------------------------------------------------------------------- Basic Annual Support US$ 300 x = -------------------------------------------------------------------- Consulting Service US$ 100/hour x = -------------------------------------------------------------------- Grand Total = ********************************************************************