ÿþ<html><!-- #BeginTemplate "/Templates/temp1.dwt" --><!-- DW6 --> <head> <!-- #BeginEditable "doctitle" --> <title>siborg.ca - order form</title> <!-- #EndEditable --> <meta http-equiv="Content-Type" content="text/html; charset=iso-8859-1"> <STYLE TYPE="text/css"> A.NAV:LINK, A.NAV:VISITED, A.NAV:ACTIVE { COLOR: #000000; FONT-SIZE: 11pt; TEXT-DECORATION: none; font-family: Arial, Helvetica, sans-serif; } A.NAV:HOVER { COLOR: #FFFFFF; FONT-SIZE: 11pt; TEXT-DECORATION: none; font-family: Arial, Helvetica, sans-serif; } </STYLE> </head> <body bgcolor="#FFFFFF" text="#000000" link="#000000" vlink="#000000" alink="#000000" onLoad="" leftmargin="0" topmargin="0" marginwidth="0" marginheight="0"> <table border="0" width="742" height="100%" cellpadding="0" cellspacing="0" > <tr> <td colspan="2" width="125" height="70"> <a href="index.html"><img src="images/page1_logo.gif" border="0"></a></td> <td width="385" height="70"> <img src="images/page1_topmiddle.gif" border="0"></td> <td width="172" height="70"> <img src="images/page1_topright.gif" border="0"></td> </tr> <tr><td colspan="4" width="742" height="1" bgcolor="#000066"><img src="imges/single.gif" height="1" width="1" border="0"></td></tr> <tr> <td colspan="4" width="742" height="19" align="right" valign="middle" bgcolor="#6699CC"> <i><b><a href="company_profile.html" CLASS="NAV"> :><?0=88</a>&nbsp;&nbsp;|&nbsp;&nbsp; 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margin-left: 3px; clip: rect( ); text-align: center; vertical-align: middle} .order { font-family: Verdana, Arial, Helvetica, sans-serif; font-size: 9pt; font-style: normal; line-height: normal; font-weight: normal; font-variant: normal; text-transform: none; color: #000000; text-decoration: none; background-attachment: fixed; background-repeat: no-repeat; background-position: center center; background-image: none; margin-left: 3px; text-align: left; vertical-align: middle} .order2 { font-family: Verdana, Arial, Helvetica, sans-serfi; font-size: 12px; font-style; normal; line-height: normal; font-weight: bold; font-variant: normal; text-tranform: none; color: #FFFFFF; text-decoration: none; background-color: #6699cc; background-image: none; background-repeat: no-repeat; clear: none; float: none; height: 25px; width: auto; text-align: center; vertical-align: middle} --> </style> <script language="JavaScript"> <!-- function MM_setTextOfTextfield(objName,x,newText) { //v3.0 var obj = MM_findObj(objName); if (obj) obj.value = newText; } function MM_popupMsg(msg) { //v1.0 alert(msg); } //--> </script> <form method="post" action="formmail.pl"> <input type="hidden" name="recipient" value="ktown@napigator.com"> <table width="500" border="0" cellspacing="1" cellpadding="0" align="center" bordercolor="#000099"> <tr align="center" valign="middle"> <td colspan="4" height="56" class="title"> <p><font face="Verdana, Arial, Helvetica, sans-serif" size="2"><b><font size="3" color="#FFFFCC" class="title"><br> Siborg Systems Inc. Software Ord</font></b></font><font face="Verdana, Arial, Helvetica, sans-serif" size="2"><b><font size="3" color="#FFFFCC" class="title">er Form</font></b></font></p> <p><b><font face="Verdana, Arial, Helvetica, sans-serif" size="2" color="#000000"><a href="orderform.pdf" onMouseOver="this.style.color='FF6600'" onMouseOut="this.style.color='000000'" target=_blank>Click here for PDF fromat</a></font><font face="Verdana, Arial, Helvetica, sans-serif" size="3" color="#000000"><br> </font></b><br></p> </td> </tr> <tr bgcolor="#FFFFFF" class="subtitlesred"> <td height="25" width="153" class="subtitlesred">Products</td> <td height="25" width="111" class="subtitlesred">Quantity</td> <td height="25" width="112" class="subtitlesred">Unit Cost (US$)</td> <td height="25" width="115" class="subtitlesred">Total Cost (US$)</td> </tr> <tr bgcolor="6699cc"> <td colspan="4" height="25" class="title"><font face="Verdana, Arial, Helvetica, sans-serif" size="3" color="#FFFFCC"><b><font size="2" color="#FFFFFF"><span class="subtitles">&nbsp<span class="subtitles"><span class="subtitles"><span class="subtitles">&nbsp; MicroTec</span></span></span></span></font></b></font><span class="subtitles"><font color="#FFFFFF"></font></span></td> </tr> <tr bgcolor="#CCCCCC"> <td width="153" valign="middle" height="20"><font face="Verdana, Arial, Helvetica, sans-serif" size="1">&nbsp&nbsp&nbsp&nbsp&nbsp; <input type="radio" name="microtec_version" value="micro_student" onClick="MM_setTextOfTextfield('microtec_price','','$ 99\r\r')"> Student *</font></td> <td rowspan="3" align="center" valign="middle" width="111" height="60"><font face="Verdana, Arial, Helvetica, sans-serif" size="1">&nbsp;</font><font face="Verdana, Arial, Helvetica, sans-serif" size="1">&nbsp;</font><font face="Verdana, Arial, Helvetica, sans-serif" size="1"> <select name="microtec_quantity"> <option value="1 micro">1</option> <option value="2 micro">2</option> <option value="3 micro">3</option> <option value="4 micro">4</option> <option value="5 micro">5</option> <option value="No Micro">None</option> </select> </font></td> <td rowspan="3" width="112" align="center" valign="middle" height="60"><font face="Verdana, Arial, Helvetica, sans-serif" size="1">&nbsp;</font><font face="Verdana, Arial, Helvetica, sans-serif" size="1">&nbsp;</font><font face="Verdana, Arial, Helvetica, sans-serif" size="1"> <input type="text" name="microtec_price" size="7" maxlength="7"> </font></td> <td rowspan="3" width="115" align="center" valign="middle" height="60"><font face="Verdana, Arial, Helvetica, sans-serif" size="1">&nbsp;</font><font face="Verdana, Arial, Helvetica, sans-serif" size="1">&nbsp;</font><font face="Verdana, Arial, Helvetica, sans-serif" size="1"> <input type="text" name="microtec_total" size="7" maxlength="10"> </font></td> </tr> <tr bgcolor="#CCCCCC"> <td width="153" valign="middle" height="20"><font face="Verdana, Arial, Helvetica, sans-serif" size="1">&nbsp&nbsp&nbsp&nbsp&nbsp <input type="radio" name="microtec_version" value="micro_academic" onClick="MM_setTextOfTextfield('microtec_price','','$ 599\r\r')"> Academic </font></td> </tr> <tr bgcolor="#CCCCCC"> <td width="153" valign="middle" height="20"><font face="Verdana, Arial, Helvetica, sans-serif" size="1">&nbsp&nbsp&nbsp&nbsp&nbsp <input type="radio" name="microtec_version" value="micro_pro" onClick="MM_setTextOfTextfield('microtec_price','','-\r\r\r');MM_popupMsg('Please contact Siborg Systems for pricing on professional versions of software!')"> Professional **</font></td> </tr> <tr bgcolor="6699cc"> <td colspan="4" height="25"><font color="#FFFFFF">&nbsp<font face="Verdana, Arial, Helvetica, sans-serif" size="2"><b>&nbsp<span class="subtitles">&nbsp;<span class="subtitles">SibLin</span></span></b></font></font></td> </tr> <tr bgcolor="#CCCCCC"> <td width="153" valign="middle" height="20"><font face="Verdana, Arial, Helvetica, sans-serif" size="1"> &nbsp&nbsp&nbsp&nbsp&nbsp <input type="radio" name="siblin_version" value="siblin_student" onClick="MM_setTextOfTextfield('sib_unit_price','','$ 99\r')"> Student ***</font></td> <td rowspan="3" align="center" valign="middle" width="111" height="60"><font face="Verdana, Arial, Helvetica, sans-serif" size="1"> <select name="# copies of siblin"> <option value="1 siblin">1</option> <option value="2 siblin">2</option> <option value="3 siblin">3</option> <option value="4 siblin">4</option> <option value="5 siblin">5</option> <option value="No Micro">None</option> </select> </font></td> <td rowspan="3" align="center" valign="middle" width="112"> <input type="text" name="sib_unit_price" size="7" maxlength="7"> </td> <td rowspan="3" width="115" align="center" valign="middle"> <input type="text" name="total$_siblin" size="7" maxlength="10"> </td> </tr> <tr bgcolor="#CCCCCC"> <td width="153" valign="middle" height="20"><font face="Verdana, Arial, Helvetica, sans-serif" size="1">&nbsp&nbsp&nbsp&nbsp&nbsp <input type="radio" name="siblin_version" value="siblin_academic" onClick="MM_setTextOfTextfield('sib_unit_price','','$ 599\r\r')"> Academic </font></td> </tr> <tr bgcolor="#CCCCCC"> <td width="153" valign="middle" height="20"><font face="Verdana, Arial, Helvetica, sans-serif" size="1">&nbsp&nbsp&nbsp&nbsp&nbsp <input type="radio" name="siblin_version" value="siblin_pro" onClick="MM_setTextOfTextfield('sib_unit_price','','-');MM_popupMsg('Please contact Siborg Systems for pricing on professional versions of software!\r\r')"> Professional **</font></td> </tr> <tr bgcolor="6699cc" align="right" valign="middle"> <td colspan="4" height="30"> <input type="text" name="total_cost" size="7" maxlength="10" value="$ " > &nbsp&nbsp&nbsp&nbsp&nbsp&nbsp; </td> </tr> <tr align="left" valign="middle" bgcolor="#FFFFFF"> <td colspan="4" height="8"> <p><font face="Verdana, Arial, Helvetica, sans-serif" size="1">&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp; * Number of nodes is limited to 600<br> &nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp; ** Please contact <a href="mailto:obrecht@siborg.ca?Subject=Pricing for professional versions of software&CC=n_obrecht2@hotmail.com " onMouseOver="this.style.color='ff6600'" onMouseOut="this.style.color='000000'" >Siborg</a> for additional pricing information<br> &nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp&nbsp; *** Number of nodes is limited to 6000 <br> </font></p> <p>&nbsp;</p> </td> </tr> </table> <table width="500" border="0" cellspacing="1" cellpadding="0" align="center"> <tr bgcolor="#CCCCCC"> <td height="30" colspan="4" class="subtitlesred"><font face="Verdana, Arial, Helvetica, sans-serif" size="2"> &nbsp&nbsp;Shipping Address </font></td> </tr> <tr bgcolor="#CCCCCC"> <td width="90" height="30" align="left"><font face="Verdana, Arial, Helvetica, sans-serif" size="2">&nbsp;Name:</font></td> <td colspan="3" height="30" align="center"> <font face="Verdana, Arial, Helvetica, sans-serif" size="2"> <input type="text" name="name" size="45" maxlength="65"> </font></td> </tr> <tr bgcolor="#CCCCCC"> <td width="90" height="30" align="left"><font face="Verdana, Arial, Helvetica, sans-serif" size="2">&nbsp;Organization:</font></td> <td colspan="3" height="30" align="center"> <font face="Verdana, Arial, Helvetica, sans-serif" size="2"> <input type="text" name="organization" size="45" maxlength="65"> </font></td> </tr> <tr bgcolor="#CCCCCC"> <td width="90" align="left" height="30" ><font face="Verdana, Arial, Helvetica, sans-serif" size="2">&nbsp;Address:</font></td> <td colspan="3" height="30" align="center"> <font face="Verdana, Arial, Helvetica, sans-serif" size="2"> <input type="text" name="address1" size="45" maxlength="65"> </font></td> </tr> <tr bgcolor="#CCCCCC"> <td width="90" align="left" valign="top">&nbsp;</td> <td colspan="3" height="30" align="center"> <font face="Verdana, Arial, Helvetica, sans-serif" size="2"> <input type="text" name="address2" size="45" maxlength="65"> </font></td> </tr> <tr bgcolor="#CCCCCC"> <td width="90" height="30" align="left"><font face="Verdana, Arial, Helvetica, sans-serif" size="2">&nbsp;City:</font></td> <td height="30" align="center"><font face="Verdana, Arial, Helvetica, sans-serif" size="2"> <input type="text" name="city" size="45" maxlength="25"> </font></td> </tr> <tr bgcolor="#CCCCCC"> <td width="90" height="30" align="left" ><font face="Verdana, Arial, Helvetica, sans-serif" size="2">&nbsp;State:</font></td> <td height="30" align="center"><font face="Verdana, Arial, Helvetica, sans-serif" size="2"> <input type="text" name="state" size="45" maxlength="25"> </font></td> </tr> <tr bgcolor="#CCCCCC"> <td width="90" height="30" align="left"><font face="Verdana, Arial, Helvetica, sans-serif" size="2">&nbsp;Zip:</font></td> <td height="30" align="center"> <font face="Verdana, Arial, Helvetica, sans-serif" size="2"> <input type="text" name="zip" size="45" maxlength="25"> </font></td> </tr> <tr bgcolor="#CCCCCC"> <td width="90" height="30" align="left" ><font face="Verdana, Arial, Helvetica, sans-serif" size="2">&nbsp;Phone:</font></td> <td height="30" align="center" > <font face="Verdana, Arial, Helvetica, sans-serif" size="2"> <input type="text" name="phone" size="45" maxlength="25"> </font></td> </tr> <tr bgcolor="#CCCCCC"> <td width="90" height="30" align="left"><font face="Verdana, Arial, Helvetica, sans-serif" size="2">&nbsp;Country:</font></td> <td height="30" align="center"> <font face="Verdana, Arial, Helvetica, sans-serif" size="2"> <input type="text" name="country" size="45" maxlength="25"> </font></td> </tr> <tr bgcolor="#CCCCCC"> <td width="90" height="30" align="left"><font face="Verdana, Arial, Helvetica, sans-serif" size="2">&nbsp;Email:</font></td> <td height="30" align="center"> <font face="Verdana, Arial, Helvetica, sans-serif" size="2"> <input type="text" name="e-mail" size="45" maxlength="45"> </font></td> </tr> </table><br> <table width="500" border="0" cellspacing="1" cellpadding="0" align="center"> <tr> <td colspan="2" class="subtitlesred">Shipping and Handling</td> </tr> <tr class="subtitles"> <td width="250" height="25" align="center" class="subtitles"><font face="verdana, arial, helvetica, sans-serfi" size="2">Canada & USA</font></td> <td width="250" height="25" align="center" class="subtitles"><font face="verdana, arial, helvetica, sans-serif" size="2">Overseas</font></td> </tr> <tr bgcolor="#CCCCCC"> <td width="250" align="left"><font face="verdana, arial, helvetica, sans-serfi" size="2"> &nbsp&nbsp; <input type="radio" name="shipcost" value="us_air20"> US $20.00 - Air Mail</font></td> <td width="250" align="left"><font face="verdana, arial, helvetica, sans-serfi" size="2"> &nbsp&nbsp; <input type="radio" name="shipcost" value="over_air30"> US $30.00 - Air Mail</font></td> </tr> <tr bgcolor="#CCCCCC"> <td width="250" align="left"><font face="verdana, arial, helvetica, sans-serfi" size="2"> &nbsp&nbsp; <input type="radio" name="shipcost" value="us_express50"> US $50.00 - Express Mail</font></td> <td width="250" align="left"><font face="verdana, arial, helvetica, sans-serfi" size="2"> &nbsp&nbsp; <input type="radio" name="shipcost" value="over_express100"> US $100.00 - Express Mail</font></td> </tr> <tr> <td colspan="2" height="30"></td> </tr> </table> <table width="500" border="0" cellspacing="1" cellpadding="0" align="center"> <tr> <td colspan="4" height="30" class="title" align="center"><font face="Verdana, Arial, Helvetica, sans-serif"><b>Payment Options</b></font></td> </tr> <tr> <td colspan="4" height="30" class="order2">Bank Wire Transfer</td> </tr> <tr bgcolor="#CCCCCC"> <td colspan="4" height="50" class="order"> <div align="center"> <p>Royal Bank of Canada, Main Branch,70-74 King St. <br> South, Waterloo, Ontario N2J 3Z6 Canada <br> Ref. MicroTec Account No. 07682 003 400 100 4 </div> </td> </tr> <tr> <td width="150" height="30" class="order" bgcolor="#CCCCCC">&nbsp&nbsp;Transaction Date:</td> <td width="100" height="30" bgcolor="#CCCCCC" align="center"> <input type="text" name="transaction_date:" size="10" maxlength="10" value="mm/dd/yy" align="center"> </td> <td width="120" height="30" class="order" bgcolor="#CCCCCC">&nbsp; Reference No.</td> <td width="130" height="30" bgcolor="#CCCCCC" align="center"> <input type="text" name="reference_no_wiret:" size="15" maxlength="15"> </td> </tr> </table> <br> <table width="500" border="0" cellspacing="1" cellpadding="0" align="center"> <tr> <td colspan="6" height="30" class="subtitles"> <div align="center">Cheque/Money Order Payable to Siborg Systems Inc.</div> </td> </tr> <tr> <td width="108" height="30" class="order" bgcolor="#CCCCCC">&nbsp;Amount $US</td> <td width="63" height="30" bgcolor="#CCCCCC" align="center"> <input type="text" name="amount_cheque/order" size="7" maxlength="15"> </td> <td width="153" height="30" class="order" bgcolor="#CCCCCC">&nbsp;Purchase Order #</td> <td width="63" height="30" bgcolor="#CCCCCC"> <input type="text" name="po#" size="10" maxlength="15"> </td> <td width="50" height="30" class="order" bgcolor="#CCCCCC">&nbsp;Date:</td> <td width="63" height="30" bgcolor="#CCCCCC" align="center"> <input type="text" name="cheque_date:" size="8" maxlength="8" value="mm/dd/yy"> </td> </tr> </table> <br> <table width="500" border="0" cellspacing="1" cellpadding="0" align="center"> <tr> <td colspan="4" height="30" class="order2">Credit Card</td> </tr> <tr> <td colspan="4" height="30" class="order" bgcolor="#CCCCCC"> <input type="radio" name="creditcard:" value="visa"> Visa <input type="radio" name="creditcard:" value="mastercard"> Mastercard </td> </tr> <tr> <td width="182" height="30" class="order" bgcolor="#CCCCCC">&nbsp&nbsp;Card Number:</td> <td colspan="3" height="30" bgcolor="#CCCCCC" width="315">&nbsp&nbsp; <input type="text" name="cardholder_number:" size="18" maxlength="18"> </td> <tr> <td width="182" height="30" class="order" bgcolor="#CCCCCC">&nbsp&nbsp;Cardholder Name:</td> <td colspan="3" height="30" bgcolor="#CCCCCC" width="315">&nbsp&nbsp; <input type="text" name="cardholder_home:" size="25" maxlength="35"> </td> <tr> <td width="182" height="30" class="order" bgcolor="#CCCCCC">&nbsp&nbsp;Expiry date:</td> <td colspan="3" height="30" bgcolor="#CCCCCC" width="315">&nbsp&nbsp; <select name="exp_date_month"> <option value="01">01</option> <option value="02">02</option> <option value="03">03</option> <option value="04">04</option> <option value="05">05</option> <option value="06">06</option> <option value="07">07</option> <option value="08">08</option> <option value="09">09</option> <option value="10">10</option> <option value="11">11</option> <option value="12">12</option> </select> &nbsp; / &nbsp; <select name="exp_date_year"> <option value="2001">2001</option> <option value="2002">2002</option> <option value="2003">2003</option> <option value="2004">2004</option> <option value="2005">2005</option> <option value="2006">2006</option> <option value="2007">2007</option> </select> </td> </table> <p align="center"><input type="submit" value="Finished"><input type="reset" value="Clear form"> </p> </form> <!-- #EndEditable --></td> </tr> </table> </body> <!-- #EndTemplate --></html>