ORDER FORM For Schedule VIEW



Selent and Associates, Inc.

23263 Harborview Rd Suite #1 Port Charlotte, FL 33980

Phone: 866-877-8555 or 941-255-3126 Fax: 503-907-7680

support@

ORDER FORM

Phone #_____________________________ _______________________________ Fax # __________________________

E-mail: ___________________________________________ Search Engine Used:__________________________________

Business Name:___________________________________________________________ Business Type:_________________

Contact Person: _________________________________________________________________________________________

Credit Card #:____________________________________________________Code:__________Exp: _______/____________

Name as it appears on credit card:___________________________________________________________________________

Address that credit card statement goes to:____________________________________________________________________

City:___________________________________________________ State:_______________ Zip:_______________________

Ship To Name:__________________________________________________________________________________________

Ship To Address (if different than above):____________________________________________________________________

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|Number of Users |Lite Edition |Standard Edition |Plus Edition |Price |

|Single user |$197 |$397 |$597 | |

|2 Users |$297 |$497 |$697 | |

|3 Users |$397 |$597 |$797 | |

|4 Users |$497 |$697 |$897 | |

|5 Users |$597 |$797 |$997 | |

|6 Users |$697 |$897 |$1,097 | |

|7 Users |$797 |$997 |$1,197 | |

|8 Users |$897 |$1,097 |$1,297 | |

|9 Users |$997 |$1,197 |$1,397 | |

|10 Users |$1,097 |$1,297 |$1,497 | |

|15 Users |$1,597 |$1,797 |$1,997 | |

|20 Users |$2,097 |$2,297 |$2,497 | |

|25 Users |$2,597 |$2,797 |$2,997 | |

|50 Users |$3,597 |$3,797 |$3,997 | |

|Add _____User(s) |$125/User |Total ___Users |Ser#:_______ | |

|Move-Up From V1 or V2 - to Version 3 |Please call for pricing and/or to order |

|WebSync |$297/Yr up to 10 Providers | |10 - $447 | |

|Requires purchase of ScheduleVIEW® |$397/Yr up to 20 Providers |$150 One time setup fee |20 - $547 | |

|Plus |$497/Yr up to 30 Providers | |30 - $647 | |

|Appointment Reminder Calls |$50/Mn up to 250 calls. |$150 One time setup fee | | |

|Requires ScheduleVIEW® Plus |251-500 Calls =18¢ | |$150 | |

| |501-600 Calls =17¢ |$150 Additional Message | | |

| |601-800 Calls =16¢ | | | |

|Technical Support |$60/Hour |Hours x $60 = __________ | |

|FL Residents Only | |7% sales tax | | |

|S&H |USA & Canada $15 |(Other Countries: $45) | |$15.00 |

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|TOTAL | | | | |

Payment Options: MasterCard, Visa, Discover and American Express are gladly accepted. Personal or company checks will be allowed to clear prior to shipment so allow 1 to 2 weeks for delivery of your permanent registration codes. Orders are shipped FedEx second day air. Because we offer a 30 day free trial, no refunds or returns are accepted. Please call if you would like 30 day demo for evaluation purposes.

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Support: One hour of telephone support is included within the first 30 days of your purchase. Additional support is $60 per hour, to be used in 15 Minute increments. 30 days of email support is included at support@. Support is also available on our website.

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