Name:
Function:	Administrator Parent Bursor Teacher ICT specialist Deputy Head Teacher Head Teacher Student Other
Organisation:
Street address:
Town, Post Code:
Work Telephone No:
Your Email Address:
License Bands:	£32 total for 2 PCs £40 total for 3 PCs £46 total for 4 PCs £50 total for 5 PCs £54 total for 6 PCs £58 total for 7 PCs £62 total for 8 PCs £66 total for 9 PCs £70 total for 10 PCs £130 total for 20 PCs £180 total for 30 PCs £220 total for 40 PCs £250 total for 50 PCs £280 total for 60 PCs £310 total for 70 PCs £340 total for 80 PCs £370 total for 90 PCs £400 total for 100 PCs £600 total for 200 PCs £750 total for 300 PCs £900 total for 400 PCs £2 each for 499+ PCs	Quantity:
Single/Multiple:	Single Network(single £costx5)	Total Value:
Serial No(s): (if known)
Media type:	electronic download CD (UK add £10)
I agree to Pay by:	Official Order, details below Official Order, details to follow Money order sent next day Cheque sent by next day Using PayPal other, specified in notes below
Send / deliver:	immediately/as soon as possible on receipt of order details wait for order & include invoice when payment made other, specified in notes below
Invoice required:	confirmation by Email is OK send proforma invoice to me send proforma invoice to Work invoice to me including Order ref. invoice to me on receipt of Order invoice to Work quoting Order ref. invoice to Work on receipt Order other, details in notes field

As applicable: Order detail/Delivery address/Additional Serial Nos/Notes: