cadence - EUROPRACTICE SOFTWARE SERVICE CADENCE SOFTWARE...

Info icon This preview shows pages 1–3. Sign up to view the full content.

View Full Document Right Arrow Icon
EUROPRACTICE SOFTWARE SERVICE CADENCE SOFTWARE ORDER FORM Please use a typewriter or complete clearly in BLOCK CAPITALS. V.20081210 Page 1 of 4 EUROPRACTICE Membership Number: ....................................................... Technical enquiries (Shipping Address) Invoice to be sent to: Name: ...................................................................................................... ................................................................................................................... Department: ...................................................................................................... ................................................................................................................... Institute: ...................................................................................................... ................................................................................................................... Address: ...................................................................................................... ................................................................................................................... ...................................................................................................... ................................................................................................................... ...................................................................................................... ................................................................................................................... ...................................................................................................... ................................................................................................................... ...................................................................................................... ................................................................................................................... Telephone: ...................................................................................................... ................................................................................................................... Fax: ...................................................................................................... ................................................................................................................... E-mail: ...................................................................................................... Payment to be made via bank transfer or cheque following your receipt of the invoice. It is currently not possible to pay by credit card. Invoice will include term Pro-Forma. If you cannot accept Pro-Forma on Invoice, tick this box Institute Purchase Order Number: ............................................................................................................................................................................................................... (Please enclose a copy of your Purchase Order) Additional Documents to be included with this order form (please tick relevant boxes) Enclosed Previously Completed Not Applicable End User Agreement (EUA) – 2 copies each containing signatures in ink (initial order only) Export Customer Use Questionnaire document (initial order only) Institute Purchase Order End Usage Statement (initial order from Research Laboratory Members only) This form should be signed by your EUROPRACTICE Representative on Page 2
Image of page 1

Info iconThis preview has intentionally blurred sections. Sign up to view the full version.

View Full Document Right Arrow Icon