                        
                        
                        B-LOGIN ORDERING FORM


Shipping Address:
__________________________
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Send to:

BLAZE Technologies
2100 S. 7th St., Centennial Square, Suite 223
Rapid City, SD, USA 57701


Person to contact in case of questions: __________________________
                                Title:  __________________________
                                Email:  __________________________
                                Voice:  __________________________
                                FAX:    __________________________


B-Login single server price                             $ 45

Number of additional copies required ____ @ $25 each    $________

In South Dakota, USA  add 4% sales tax                  $________

Total Due in US dollars                                 $________

Ordering Date __/__/__

Netware version currently being used: __ V2.2 __ V3.1x __V4.0x

What other network utilities would you like to see developed?
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Thank you for supporting B-Login!

