===================== VirusNet/Pro Request Form ======================

A. Fill out this form using the standard text editing keys.
B. When finished, select the Print menu option.
C. Print the completed form to a printer or file.
D. Send us this completed form by phone, fax, mail, E-Mail or BBS.

Date: 
Name: 
Company: 
Address: 
City, State, Zip: 
Country: 
Phone: 
Fax: 

----- Please complete the following questions -----

1. What is your time-frame for purchasing VirusNet/Pro? 
   (Select One)   ( )Now  ( )2 Months  ( )6 Months  ( )Reference Only

2. Where did you receive this demo copy? 

3. # of standalone PCs to run VirusNet/Pro? 

4. # of network file servers to run VirusNet/Pro? 
    If none, please skip to question 5.

    Which network operating system do you have? 
    # of network PCs to run VirusNet/Pro from their hard disk? 
    # of network PCs to only run VirusNet/Pro from the server? 

5. I'm also interested in ( )Security, ( )Menuing, ( ) HW/SW Inventory

Comments:



======================================================================
Submit this completed form by phone, fax, mail, E-Mail or BBS to:

Safetynet, Inc.
Customer Service Dept.
55 Bleeker Street
Millburn, NJ 07041-1414 USA

Sales      - 1-800-851-0188
Support    - 1-201-467-1024
Fax        - 1-201-467-1611
BBS        - 1-201-467-1581 (14400,N,8,1)
CompuServe - GO SAFE
E-Mail     - 74431.1646@compuserve.com

International Sales - +1 908-276-9641
International Fax   - +1 908-276-6575