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  1.                           GroupShade (tm) Order Form
  2.    
  3. Please register a copy of GroupShade:            To register an order:
  4.                                                  Call (617) 393-5460
  5. 1 Your Name [______________________________]     Fax  (617) 393-5461
  6.   Telephone [______________________________]     or Mail this form to:
  7.  
  8.                                                  Ethosoft, Inc.
  9.                                                  196 Boston Ave., Suite 3500
  10.                                                  Medford, MA. 02155
  11. 2 LICENSE TYPE
  12.  
  13.   GroupShade is sold on a per node        Units  Nodes   Price  Total Price 
  14.   basis allowing all nodes to share     +-------+-----+---------+-----------+
  15.   their screen savers.  You can         | [   ] |   5 | $ 19.50 | [       ] |
  16.   upgrade at any time to increase       | [   ] |  10 | $ 34.50 | [       ] |
  17.   the number of simultaneous node       | [   ] |  20 | $ 49.50 | [       ] |
  18.   connections.                          | [   ] |  25 | $ 59.50 | [       ] |
  19.                                         | [   ] |  50 | $ 99.50 | [       ] |
  20.   Note: Upon receipt of payment a       | [   ] | 100 |$ 149.50 | [       ] |
  21.   confirmation letter will be sent      | [   ] | 250 |$ 199.50 | [       ] |
  22.   documenting your registration and     +-------+-----+---------+-----------+
  23.   license type.                                       Subtotal: | [       ] |
  24.                                                  Mass Residents |           |
  25.                                                     add 5% TAX: | [       ] |
  26.                                                    Order Total: | [       ] |
  27.                                                                 +-----------+
  28. 3 BILL TO
  29.  
  30.   Name:       [____________________________________________]
  31.   Company:    [____________________________________________]
  32.   Street:     [____________________________________________]
  33.               [____________________________________________]
  34.   City:       [____________________________________________]
  35.   State, Zip: [____________________________________________]
  36.  
  37. 4 SHIP TO (if different than above)
  38.   
  39.   Name:       [____________________________________________]
  40.   Company:    [____________________________________________]
  41.   Street:     [____________________________________________]
  42.               [____________________________________________]
  43.   City:       [____________________________________________]
  44.   State, Zip: [____________________________________________]
  45.  
  46. 5 PAYMENT
  47.  
  48.   We accept company purchase orders (credit subject to approval), VISA,
  49.   MasterCard, American Express, COD, checks, and money orders (check one).
  50.  
  51.   P.O. # [_____________________________________]
  52.   [_] VISA  [_] MC  [_] AmEx  [_] Check  [_] Money Order  [_] COD
  53.  
  54.   Credit Card # [_________________________________________]
  55.   Expiration    [_____________]
  56.  
  57.   Signature     [_________________________________________]
  58.