#### Softinabox Password Safe Order Form

NOTE: You can order this product on-line by running it and selecting "Buy On-line" from the "Help" menu.

To print this order form, press the Print button above.

To order by check, please send this order form and a check to:

> Hugo Alexandre Ribeiro
> Rua Simões de Almeida, 25
> 4710-444 Braga
> PORTUGAL

Important: Payments must be is US dollars. You can also send international postal orders in US dollars.

All orders are subject to the License Agreement.

Customer information is considered confidential and will not be shared or distributed to any third parties.

Registered users of Softinabox Icon Explorer are entitled to unlimited free software updates and email technical support.

Product Licensing:

Licensing | Quantity | Unit Price | Total
Single User Licensing |  | 15.00 USD |
Multiple User Licensing |  | 300.00 USD |
|  | Total |

Order Details:

Date |
Name |
Organization |
Address |
City |
State |
Zip Code |
Country |
Day Phone |
Email Address |
Comments |

Important:

- Please be sure to include all the required information.
- All the orders received will only be considered valid after payment validation.

Note:

- This order form is also available in the help file.