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  1.  
  2.  
  3.  
  4.                    +----------------------------------+
  5.                    |      O R D E R   F O R M         |
  6.                    | for Crynwr packet driver support |
  7.                    +----------------------------------+
  8.  
  9.  
  10.     Date [             ]
  11.  
  12.  
  13.     Order from:  Crynwr Software       Telephone:  +1-315-268-1925
  14.                  11 Grant St.          FAX:        +1-315-268-9201
  15.                  Potsdam, NY 13676     Email:      info@crynwr.com
  16.  
  17.  
  18.     Ship to:                            Bill to:
  19.  
  20.     [                             ]     [                             ]
  21.     [                             ]     [                             ]
  22.     [                             ]     [                             ]
  23.     [                             ]     [                             ]
  24.     [                             ]     [                             ]
  25.  
  26.     Yearly support fee for one network:   [    ] networks x $ 200 = [     ]
  27.     Yearly support fee for one site:      [    ] sites    x $2000 = [     ]
  28.                                                            Subtotal [     ]
  29.     Educational users apply a 25% discount.      Subtotal x -25%    [     ]
  30.                                                               Total [     ]
  31.  
  32.     Special pricing is available for special circumstances.
  33.  
  34.     Form of payment
  35.     [ ]    Purchase order number [                 ]
  36.     [ ]    Check drawn in US funds
  37.     [ ]    Wire transfer (ask for details).
  38.  
  39.