Fill out this form to order the NGWFIX1 commercial version from NEAT. 
Fax it to: +31-20-5608610

Customer details	
Company name
		
Name
		
Function
		
Address

Zip code
		
City / state
		
Country
		
Phone
		
Fax
		
Email address

Order detail	
Your ordernumber
		
Domain name used in GroupWise system.		
Desired license

(check only one)	10 user

US$ 100	25 user

US$ 225	100 user

US$ 500	250 user

US$ 750	Unlimited

US$ 1000	

Creditcard details	
Creditcard number
		
Registered to
		
Expiration date
		
Signature

Type of card
	AMEX	EURO/MASTER	VISA