SurveyGold Order Form

TO ORDER: Print this form, complete it and mail or fax it to:

Golden Hills Software, Inc.
Attention: Order Processing
6512 Hawkeye Circle
Colorado Springs, CO 80919
Fax: 719-623-0317
Sales: 719-660-6272

Date:

About You
Name:
Organization:
Phone:
Mailing Address: (No post office boxes)
E-Mail:
Payment Options (Choose One)
(Option 1) PO #
(Option 2) Payment	Include payment as specified below**

Your Order

Description

Price*

Quantity

Extended Total

SurveyGold for Windows Standard Edition
Product ID: 42918

Individual license	199.00
Site license***	1999.00
Corporate license****	Call

SurveyGold for Windows Professional Edition
Product ID: 56941

Individual license	299.00
Site license***	2999.00
Corporate license****	Call

Shipping & Handling

12.00

Grand Total

* All prices are in US Dollars and are subject to change without notice. Should there be a difference between our published prices and the price indicated on your order, we will ask for your approval before your order is processed.

All faxed orders must include one of the following:

- purchase order and/or purchase order number

**All mailed orders must include one of the following:

- purchase order and/or purchase order number
- prepaid check payable in U.S. dollars and drawn on a U.S. bank
- certified bank draft drawn in the hard currency of the issuing bank
- American Express money order
- U.S. or International postal money order
- cash in a hard currency (Golden Hills Software, Inc. takes no responsibility if you send cash, and suggests that if you do so the order be sent by registered mail.)

*A site license allows multiple copies of SurveyGold to be loaded from a CD-ROM onto an unlimited number of computers at your site as described in the site license agreement.
**A corporate license allows multiple copies of SurveyGold to be loaded from a CD-ROM onto an unlimited number of computers at any corporate factility as described in the corporate license agreement.