Software/Service Order Form
To place an order for the software, service product specified below, please complete this worksheet. Once completed, please FAX (303-449-0797) or mail this worksheet (with the payment method specified or a check enclosed) to GBS, Inc. Your order will be processed and shipped the day we receive your request. Your software should be received within two days. If you have any questions or wish to simply place your order over the phone, please contact a GBS, Inc. Sales Representative at 800-231-8495 Ext. 505.
Please Complete the Service and/or rush the software to: S/N: ______
Name of Purchaser: ______Phone Number (required): ______
Name of Agency: ______FAX Number: ______
Name of Contact (if different from Purchaser: ______
Physical Address (No P.O. Boxes Please): ______
City: ______State: ______Zip Code: ______- ______
Pricing Worksheet
Please complete the following worksheet to figure your pricing:
Select the Software Package/Service(s) you wish to purchase:
r Telephone Training Non-Refundable $100 per hour $ ______
r Conversion/Data Importing Non-Refundable $100 per hour $ ______
r Custom Database work Non-Refundable $100 per hour $ ______
r Replacement Sys. (overnight) Non-Refundable $35 (includes shipping) $ ______
r Replacement Sys. (1st Class) Non-Refundable $20 (includes shipping) $ ______
r System Manual (Priority Mail) Non-Refundable $25 (includes shipping) $ ______
r Merge two GBS databases Non-Refundable $395 $ ______
r Comm. Chk Window Envelopes Non-Refundable $140/thousand* $ ______
r Access Database Unlock Non-Refundable $100/year - pro rated 1st yr. $ ______
r Add’l Shipping Charges** Non-Refundable ______$ ______
r ______Non-Refundable ______$ ______
CoLo. Sales Tax** $ ______
Total Charge $ ______
Other Notes:
* Note that envelopes are self sealing. Shipping for envelopes is $15/thousand. Colorado customers must pay sales tax.
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Desired Payment Mode: r VISA r MasterCard r AMEX r Discover r C.O.D. r Check Enclosed
Credit Card Number: ______Exp. Date: ______Card Security Code: ______
Credit Card Billing Address (to Which Statements are Mailed): ______Billing Zip Code: ______
AUTHORIZATION NOTICE!
The undersigned authorizes GBS, Inc. to charge the above card for the specified amount. All of the Software Packages and services shown above are Non-Refundable under any and all circumstances. This agreement shall be governed by Colorado Law and venue shall be proper in Boulder County, State of Colorado.
Signature (Required): ______, Title: ______Date: ______
sw_order.doc – 8/26/2011 (SOFTWARE/SUPP)