PACE Software Request Form for Gamma Technologies (GTI) GT-Power Software

Complete the information below and e-mail it to:

Name of Institution: Date:

Name of Person Submitting Request

Title of Person Submitting Request:

E-Mail Address:

Phone: Fax:

Shipping Address:

Server Name

Server ID

MAC IDs

With this form, the PACE Institution above is requesting two (2) floating licenses of GT-Power for classroom purposes only (not for funded research) for a period of one year, with the ability to continue those licenses into future years. The institution will be required to pay Gamma Technologies, Inc.a flat annual administrative fee of $200 (U.S. Currency) for the first year and $400 (U.S. currency) for each year thereafter.

This also entitles the institution to request up to 30 additional licenses for classroom use for a maximum period of two weeks. These additional licenses may be requested any time after the two floating licenses have been deployed. There is no additional cost for these temporary classroom licenses. To request these temporary licenses, contact John Silvestri at .

Software provided under this agreement is for Classroom Support. This does not include funded academic work (research or consulting). Funded academic work should only be conducted using a separate license agreement independent of the PACE program.

If an institution needs a larger pool of licenses and/or for a longer period of time, then a PACE Petition of Exception for GT Power must be filed with the PACE Office. Also, if there is some special use that is requested, the petition form must also be filed (available on the PACE web site or by contacting the PACE Office). GTI will review all such requests and make the decision on the petition.

A standard software user agreement will be required of the institution by GTI at the time of software deployment.

(If your institution has a current agreement with GTI for GT-Power, the PACE offer described above will be made available at the end date of that agreement.)

YES- My institution is requesting two (2) floating university licenses for GT-Power based upon the information and requirements above.

The software will be loaded on the following platform at my institution (see the list of supported platforms on the PACE Offer Information Sheet or on

My institution currently receives GT-Power:

YES

NO

If yes, please indicate the end date of your current license agreement:

YES - My institution is also interested in receiving temporary classroom licenses of GT Power and will contact John Silvestri as needed. (Maximum of 30 licenses for 2 weeks)

For office use only

GTI Decision:

ApprovedNot Approved

Comment:

______

GTI RepresentativeDate

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PACE Software Request Form for Gamma Technologies (GTI) GT-Power Software Modified 8/20/2009