GroupEase (tm) Order Form Please send me GroupEase: To place an order: Call (617) 393-5460 1 Your Name [______________________________] Fax (617) 393-5461 Telephone [______________________________] or Mail this form to: Ethosoft, Inc. 196 Boston Ave., Suite 3500 Medford, MA. 02155 2 LICENSE TYPE GroupEase is sold on a per Server Units Nodes Price Total Price basis allowing 5, 10, 20, 25, 50, +-------+-----+--------+-----------+ 100 and 250 nodes to access the | [ ] | 5 | $ 195 | [ ] | functionality. You can upgrade at | [ ] | 10 | $ 350 | [ ] | any time to increase the number of | [ ] | 20 | $ 595 | [ ] | simultaneous node connections. | [ ] | 25 | $ 695 | [ ] | | [ ] | 50 | $ 1250 | [ ] | | [ ] | 100 | $ 1995 | [ ] | | [ ] | 250 | $ 4495 | [ ] | +-------+-----+--------+-----------+ Subtotal: | [ ] | Shipping Charges Mass Residents | | Ground: $ 6.00 add 5% TAX: | [ ] | 2 Day Air: $ 11.00 Shipping: | [ ] | Overnight: $ 16.00 Order Total: | [ ] | +-----------+ 3 BILL TO Name: [____________________________________________] Company: [____________________________________________] Street: [____________________________________________] [____________________________________________] City: [____________________________________________] State, Zip: [____________________________________________] 4 SHIP TO (if different than above) Name: [____________________________________________] Company: [____________________________________________] Street: [____________________________________________] [____________________________________________] City: [____________________________________________] State, Zip: [____________________________________________] 5 PAYMENT We accept company purchase orders (credit subject to approval), VISA, MasterCard, American Express, COD, checks, and money orders (check one). P.O. # [_____________________________________] [_] VISA [_] MC [_] AmEx [_] Check [_] Money Order [_] COD Credit Card # [_________________________________________] Expiration [_____________] Signature [_________________________________________]