|
Please complete the
following information and return a copy of this form, along with a check
for the total amount owed, to:
CSB Systems Manager
Community Shelter Board
115
West Main Street, LL
Columbus, OH 43215
Agency Name:
The
above Connecting Agency is purchasing the following:
|
No. of Licenses
|
Price Per License
|
|
ServicePoint User Licenses:
|
|
$225.00
|
|
Total Amount Enclosed:
|
|
|
A check for the total amount of this purchase is included with this
form.
Upon
electronic “receipt” of User Licenses, please notify:
______________________________________________________________
Name
Phone/Email
|
