Keystone Licensing Information Form

                            Stonekeep Consulting
                              9 Bayberry Road
                             Natick, MA  01760

        $Id: licenseform.txt 253 2006-12-15 01:37:34Z dbs $

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Instructions |
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1) Download this form and print it out
2) Fill it out
3) Fax it to the above number

If you select PLEASE INVOICE ME:
4a) You will receive an invoice for the appropriate amount.  

If you select CHECK IS BEING MAILED:
4b) Mail a check to the above address, made out directly to
	'Stonekeep Consulting, Inc' for the appropriate fee (as indicated
	below)  You will receive a receipt via email, fax, or snail
	mail, as indicated below.

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Licensee Details |
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Company Information:

Company Name:	_____________________________________________________

Address:	_____________________________________________________

		_____________________________________________________

City, St, Zip	_____________________________________________________

Country		_____________________________________________________


Contact Information:

Contact Name:	_____________________________________________________

Phone number:	_____________________________________________________

Fax:		_____________________________________________________

Email address:	_____________________________________________________


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License Type |
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(See http://www.stonekeep.com/license.html for more information 
on License Types)

	[  ]	10-25 users	$500.00 / year

	[  ]	26-100 users	$2000.00 / year

	[  ]	100+ users  	________ / year (large scale licenses
				MUST be negotiated and approved through
				Stonekeep Consulting)

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Payment type |
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	[  ]	Mailed check to above address, made out to 
		Stonekeep Consulting, Inc

	[  ]	Please invoice me

	Please send invoice / receipt via:

	[  ]	Email

	[  ]	Postal (snail) mail

	[  ]	Fax

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SIGNED:	____________________________________________

Title:	____________________________________________

Date:	____________________________________________