======================= VirusNet Request Form =======================

A. Fill out this form using the standard text editing keys.
B. When finished, select the Print menu option.
C. Print the completed form to a printer or file.
D. Send us this completed form by phone, fax, mail, E-Mail or BBS.

Date: 
Name: 
Company: 
Address: 
City, State, Zip: 
Country: 
Phone: 
Fax: 

----- Please complete the following questions -----

1. What is your time-frame for purchasing VirusNet? 
   (Select One)   ( )Now  ( )2 Months  ( )6 Months  ( )Reference Only

2. Where did you receive this demo copy? 

3. # of standalone PCs to run VirusNet? 

4. # of network file servers to run VirusNet? 
    If none, please skip to question 5.

    Which network operating system do you have? 
    # of network PCs to run VirusNet from their hard disk? 
    # of network PCs to only run VirusNet from the server? 

5. I'm also interested in ( )Security, ( )Menuing, ( ) HW/SW Inventory

Comments:



======================================================================
Submit this completed form by phone, fax, mail, E-Mail or BBS to:

Safetynet, Inc.
Customer Service Dept.
140 Mountain Ave.
Springfield, NJ 07081 USA

Sales      - 1-800-OS2-SAFE
Support    - 1-201-467-1024
Fax        - 1-201-467-1611
BBS        - 1-201-467-1581 (28800,N,8,1)
CompuServe - go cis:safe

E-Mail     - safety@safe.net
FTP        - ftp://ftp.safe.net /pub/safetynet/
WWW        - http://www.safe.net/safety/

International Sales - +1 908-276-9641
International Fax   - +1 908-276-6575