ORDER FORM - Impel Class Info v1.2 Name:__________________________________Date:_____________________________ Company:_________________________________________________________________ Address:_________________________________________________________________ _________________________________________________________________ City:_________________________________ State:_________ Zip:______________ Country:______________________________ Phone:____________________________ Fax:__________________________________ E-Mail:___________________________ Impel Class Info Price/Unit Quantity Total ------------------------------------------------------------------------- | 1 - 10 units | $10.00 | | | |----------------------------------------|-----------|--------|---------| | 11 - 24 units | $8.00 | | | |----------------------------------------|-----------|--------|---------| | Site License (25+ units) | $213.00 | 1 | | |----------------------------------------|-----------|--------|---------| | Source Code (VB v5.0, non-refundable) | $95.00 | 1 | | --------------------------------------------------------------|---------| Prices good through 12/31/1998 Sub Total | | Media: 3.5" High Density diskette |---------| Fixes/Updates: No charge Tax (MN residents 6.5%) | | |---------| Shipping and Handling (see rates below) | | |---------| Total | | ----------- Shipping and Handling Rates: U.S. Canada International ------------------------------------------------------------------------- U.S. Mail ...... $ 5.00 U.S. Mail ...... $ 6.50 U.S. Mail ...... $13.00 FedEx 2nd Day .. $12.00 FedEx 2nd Day .. $18.00 FedEx Priority . $32.00 FedEx Standard . $16.00 FedEx Standard . $21.00 FedEx Priority . $19.00 FedEx Priority . $24.00 ------------------------------------------------------------------------- Payment Method (select one): [ ] Check or Money Order (U.S. funds only) made out to Impel Solutions Corp [ ] Purchase Order (orders over $150.00 only) PO Number:___________________ Remit Payment to: Impel Solutions Corporation 17452 Iceland Trail Suite 112 Lakeville, MN 55044 (612) 898-4423 TERMS Payment is accepted via check or money order (U.S. funds from a U.S. bank); company purchase order at Net 30 days for orders over $150.00 and upon credit approval from large corporations within the U.S.A. and Canada. All licenses are prepaid only. All orders outside the U.S.A. and Canada must be prepaid. No runtime license fees will be charged with your compiled applications for source code purchases. Source code purchases are non-refundable. Please make remittance payable to Impel Solutions Corporation. Prices, terms and conditions subject to change without notice. Note: Credit card ordering will begin January 1999.