Virtual Access Order Form

Fax to:	+44 (0)1297 553366
Mail to:	Atlantic Coast plc., 
		The Shareware Village, 
		Colyton, 
		Devon, 
		England, 
		EX13 6HA

Please supply me with the following products:

Copies Product						Unit Cost	Total
[   ] Virtual Access single user			$ 59.95	$____.__
[   ] Virtual Access PlusPack				$ 25.00	$____.__
[   ] Virtual Access (2 User)				$ 79.00	$____.__
[   ] Virtual Access (3-5 User)			$149.00	$____.__
[   ] Virtual Access (6-10 User)			$249.00	$____.__
[   ] Virtual Access (11-20 User)			$339.00	$____.__
[   ] Virtual Access (21-50 User)			$479.00	$____.__
[   ] Virtual Access (51-100 User)			$679.00	$____.__
[   ] Virtual Access (unlimited single server)	$849.00	$____.__
[   ]  Extended Support (+50% of license)				$____.__

			    TOTAL DUE					$____.__
To:-
Name		___________________________________________

Company	___________________________________________

Address	___________________________________________

        	___________________________________________

      	___________________________________________

		___________________________________________

Postcode	___________________________________________

Payment	[  ] Credit Card (we take all credit cards!)

		Card Type:		____________________

		Number:		_______________________ 	Expiry ___/___

		Name on Card: 	__________________________________
	
		[  ] Check (send by traditional mail)
		made out to Atlantic Coast plc.

VAT/Local Taxes will be added if applicable