O R D E R F O R M  for  N G W F I X 1

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


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| Customer details                                                       |
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| Company name :                                                         |
| Name         :                                                         |
| Function     :                                                         |
| Address      :                                                         |
|              :                                                         |
| Zip code     :                                                         |
| City / state :                                                         |
| Country      :                                                         |
| Phone        :                                                         |
| Fax          :                                                         |
| Email address:                                                         |
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| Order detail                                                           |
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| Your ordernumber    :                                                  |
| Domain name used in                                                    |
| GroupWise system    :                                                  |
+------------------+---------+---------+----------+----------+-----------+
| Desired license  | 10 user | 25 user | 100 user | 250 user | unlimited |
|                  | US$ 100 | US$ 225 | US$ 500  | US$ 750  | US$ 1000  |
|                  +---------+---------+----------+----------+-----------+
| (check only one) |         |         |          |          |           |
+------------------+---------+---------+----------+----------+-----------+


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| Creditcard details                                                     |
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| Creditcard number:                                                     |
| Registered to    :                                                     |
| Expiration date  :                                                     |
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| Signature                                                              |
|                                                                        |
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| Type of card  |       AMEX       |   EURO/MASTER    |       VISA       |
+---------------+------------------+------------------+------------------+