Kermit 95 Academic Site License Order Form

[20030101]

Use this form to order a Kermit 95 academic site license. All prices are in US dollars. The software is furnished on CDROM. With the Annual Billing option, you pay the amount shown below the first year, and then 50% of that amount each subsequent year for support and upgrades. The Lifetime option entitles your institution to support and upgrades for the lifetime of the Kermit 95 product. See the Kermit 95 Pricing and Licensing document for details.

Return this form by e-mail to kermit-orders@columbia.edu,
or by fax to +1 (212) 662 6442,
or by post to: 
  The Kermit Project
  Columbia University
  612 West 115th Street
  New York NY  10025-7799
  USA

CHECK ONE BOX ONLY: 
                          Annual Billing      Lifetime License
  Single University:         [  ] $ 2000           [  ] $ 5000
  University System:         [  ] $10000           [  ] $25000

A. Amount of license: . . . . . . . . . . . . . . . . . . . . . . $_________

The name of your institution as you would like it to appear in the registration screen: 

  _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
  (31 characters maximum)

Now please fill out one of the following three payment sections and then fill out the shipping information at the end.

1. PAYMENT BY CREDIT CARD NOTE: We can accept only MasterCard and Visa. 
[ ] MasterCard [ ] Visa   AMOUNT OF YOUR PAYMENT . . . . . . . $_________

Cardholder's name: ______________________________________________________

Card Number _____________________________   Expiration Date _____________

Signature _______________________________   Today's Date ________________
2. PREPAYMENT BY CHECK 
Purchase order number, if any: ___________________

Amount from Line A above . . . . . . . . . . . . .  $________

If your check is not drawn on a US bank,
please add a $65.00 check-cashing fee: . . . . . .  $________

TOTAL AMOUNT OF YOUR CHECK:  . . . . . . . . . . . . . . . . .  $________
Please enclose a check for the total amount payable in US dollars. Make your check payable to:
The Kermit Project - Columbia University
Note: The $65.00 collection fee on non-domestic checks is charged by Columbia University's bank, The Chase Manhattan Bank. We have no control over it. Address complaints to The Chase Manhattan Bank, 4 Chase MetroTech Center, 6th Floor, Brooklyn NY 11245, USA.

3. NON-PREPAID PURCHASE ORDERS 
Company PO Number:__________________

B. Amount from Line A above:                       $________
C. Add $25 invoicing (billing) fee:                $________
D. If your check will not be drawn on a US bank,
      add $65 check-cashing fee:                   $________
E. If you will pay by wire wire transfer,
      add $25 bank fee:                            $________

TOTAL, Lines B, C, and D, and and E.
Please enclose your purchase order for this amount: . . . . . . $________
SHIPPING INFORMATION 
Name:____________________________________________________________________

Organization:____________________________________________________________

Address:_________________________________________________________________

City:__________________________________ State/Province:__________________

ZIP or Postal Code: ___________________ Country: ________________________

E-mail: _______________________________ Telephone: ______________________

(Thank you!)