WUSAGE KEY ORDER FORM

Please fill out this form completely.  ** Missing information may delay your
receipt of your key to unlock Wusage! **  Tell your purchasing department
that WE NEED THIS FORM and your e-mail address to send you a key!  Mail to:

Boutell.Com, Inc.
PO Box 63767
Philadelphia, PA 19147 USA

Copies Ordered:    ______    Total Enclosed:    $ ______
($25/Copy nongovernmental nonprofit/educ.; $75/copy all others, call for 
volume pricing. ISP PRICE for many virtual domains at one location: $295.
Remote installation (Unix only): add $200 for single copies, add $300 for ISP. 

Checks must be in U.S. funds drawn on a U.S. bank. We also accept credit 
cards; credit card orders may be faxed or telephoned to +1 206 658-8176.
International bank transfers: you must call us first!

Your Status: ___ Nonprofit(*) ___ Educational(*)  ___ All Others

(*) Nonprofit and educational institutions MUST PROVIDE EVIDENCE of their
non-commercial status.  Evidence can be I.R.S. documentation; this form or
a note printed on school letterhead; or a copy of the organization's brochure
clearly indicating non-profit status. Individuals, governments, 
and governmental agencies do NOT qualify as educational or non-profit.  If you
have a question, call us at +1 206 658-8176.

Select: ___ Check/Money-Order ___ Credit Card ___________ Purchase Order Number

Credit Card:  ___ Discover  ___ Visa   ___ Mastercard ___ American Express

   If you are paying by credit card, we must have the following information:

   Credit Card Number: ______ ______ ______ ______ Expiration Date: ____/____

   Name as it Appears on the Card:    __________________________

   Cardholder's Signature:            __________________________

Your key will be sent to (please type or print CLEARLY):

E-mail Address (Important!):   _________________________

Name:                    _______________________________

Organization (Optional): _______________________________

Complete Street Address: _______________________________

                         _______________________________

                         _______________________________

                         _______________________________

Country:                 _______________________________

You will receive your key by email, and a receipt by postal mail. Thank you!