Micronex®—Academic Site License

Thank you for your interest in MinIdent-Win. Please complete this form and attach it to your official institutional purchase order.

Name of purchasing authority ______________________________________________________________________

Address of purchasing authority ____________________________________________________________________

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Address for delivery if different from above __________________________________________________________

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Phone number of purchasing authority ______________________________________________________________

Fax number of purchasing authority ________________________________________________________________

email address of purchasing authority ______________________________________________________________

Official name of end-user Department _______________________________________________________________

Phone number of Department’s contact person ______________________________________________________

Fax number of Department’s contact person _________________________________________________________

email address of Department’s contact person _______________________________________________________

Select One of the following by entering the appropriate amount opposite it:

*License for 1 copy of the MinIdent-Win software (full Professional Edition) US$300……………. __________

*Licenses for 2 copies of the MinIdent-Win software (full Professional Edition) US$400……….. __________

*Licenses for 3 copies of the MinIdent-Win software (full Professional Edition) US$500……….. __________

*Licenses for 4 copies of the MinIdent-Win software (full Professional Edition) US$600……….. __________

*Licenses for 5 copies of the MinIdent-Win software (full Professional Edition) US$650……….. __________

*Licenses for 6 copies of the MinIdent-Win software (full Professional Edition) US$700……….. __________

*Licenses for 7 copies of the MinIdent-Win software (full Professional Edition) US$750……….. __________

*Licenses for 8 copies of the MinIdent-Win software (full Professional Edition) US$800……….. __________

*Licenses for 9 copies of the MinIdent-Win software (full Professional Edition) US$850……….. __________

*Licenses for 10 copies of the MinIdent-Win software (full Professional Edition) US$900………

*Licenses for ____ addition copies of the MinIdent-Win software (full Professional Edition)

@ US$25 each (enter amount opposite)…………………………………………………………………… ____________

Add packing & shipping by mail @ US$20 (any number of copies) .…………………….…..……… ____________

or substitute courier charges for quicker delivery @ US$50 (any number of copies) ………….. ___________

Add GST or VAT (if applicable—No GST or VAT on any order placed before 01JAN08) ……….. ____________

Grand Total (US$) …...…………..….………...…………..….………...…………..........................…… ___________

†Grand Total (CAN$ equivalent) …….………...…………..….………...…………........................….. __________

†If desired, payment can be made in Canadian currency by using the conversion rate shown on the Micronex website (http://www.micronex.ca/index.php?idx=5)

TO BE COMPLETED BY PURCHASING AUTHORITY

Please supply the software licenses indicated above. I hereby certify that the software supplied under this Academic License Agreement will be used for academic purposes only and will not be used, nor rented out for use, commercially:

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NAME POSITION SIGNATURE

DATED AT THIS DAY OF IN THE YEAR

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Each copy is licensed for installation on one (1) computer platform only and bears a unique product code

which is required for installation and registration.

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(Please note that the product cannot be registered and fully activated until payment has been received)

Send your completed order to: Micronex®, 4356 - 148 Street, Edmonton, Alberta, Canada, T6H 5V5.

For Micronex Use—please do not write in this area.