McHenry Software, Inc. m-smac/m-edit Order Form

For Government/Education/Research (GER) Discount Program

(please note that your identity and all information provided on this form is considered confidential by McHenry Software, Inc. and will not be disclosed)

Please check appropriate lines and total:

___ First year GER license US$1500

____ Additional GER Licenses (CALL, additional discounts may apply, please request a quote)

___ NC residents add sales tax US$90

$_________Total in US funds

(Please Note: a license renewal/maintenance fee of US$500 per license is charged on the 1st anniversary of the order date and each anniversary thereafter,$400 with quick pay discount)

• Date of Order:________________
• Licensee Name: ____________________________________________
• Licensee Organization: _______________________________________
• Address1: ___________________________________________
• Address2: ___________________________________________
• City, State, Zip: ________________________________________
• Country: ________________________________________
• Phone: _____________________________
• Fax: _______________________________
• e-mail: _______________________________________________
• Computer Type ______________(Pentium/60 or faster recommended)
• Memory: _____(8 mg or more recommended)
• Target Operating System ____________(Win3.xx,WFWG,Win95,WinNT, Win2000, WinXP, etc)
• ____ Check here if you would like to receive the McHenry Software License Agreement by FAX
• If additional License for company/organization, please list all additional Licensee names:
• ____________________________________________________________________________________

If a Mastercard/VISA Order: (See Return Policy Below)

Please enter MasterCard/VISA Number: __ __ __ __- __ __ __ __- __ __ __ __- __ __ __ __

Expiration Date: __ __ / __ __
Signature______________________________________________

BY MAIL:

send completed form with check, money-order or MasterCard/VISA Information to:

BY FAX:

RETURN POLICY: Installation and/or use of our software is subject to the McHenry Software License Agreement and Limited Warranty. Upon request we can fax a copy of the License Agreement for your review and approval prior to shipment of the order. Note that once an item is shipped, a shipping and handling fee of $100. will apply for any canceled or returned orders.