ELECTRONIC CONSENSUS, INC.
24 James Street
Shoreham, N Y 11786

ALL TOGETHER NOW
ORDER FORM

Please list each site.  Each site will receive individually licensed software.
Price per site license:  $1495. Education discounts available to schools.

Version ordered: ___MSDos/IBM     ___Macintosh
Site: __________________________________________
Address________________________________________
______________________________________________
______________________________________________
Contact:_____________________ Phone:__________________________ Fax:______________________ Email:_____________________________


Version ordered: ___MSDos/IBM     ___Macintosh
Site: __________________________________________
Address________________________________________
______________________________________________
______________________________________________
Contact:_____________________ Phone:__________________________ Fax:______________________ Email:_____________________________


Version ordered: ___MSDos/IBM     ___Macintosh
Site: __________________________________________
Address________________________________________
______________________________________________
______________________________________________
Contact:_____________________ Phone:__________________________ Fax:______________________ Email:_____________________________


Number of sites ____x $1495 per site =  ________Total
Method of payment: ___Purchase Order No._______    or ___Check
Ship to:___________________________________________________________ _________________________________________________________________
_________________________________________________________________
_________________________________________________________________  

Vist our web page at: www.drtomkelly.com/alltognow

TAX ID # 11 328 1633