Software/Services Selection:

Item Setup Charge Monthly Rate BizWizard Order Manager: $0.00 $0.00 BizWizard ShopKart     $0.00 $0.00           Promo Code: Bundle/Promo Discount: ($0.00) ($0.00)     =========== ========== Month to Month? Totals: $0.00 $0.00

Customer Information:

Company Name: * (e.g. Awards Store USA) Address One: * (e.g. 1234 N. Main Street) Address Two: * (e.g. Reno, NV 89506) Address Three:   Phone: * (e.g. 775-996-1343) Toll-Free Phone: (e.g. 877-370-6870) Fascimile Phone: (e.g. 775-986-5127)   Web Site Addresses Current Web Site: http:// ShopKart Web Site: http://   Responsible Party Name: * (e.g. John Doe) Address One: * (e.g. 1234 N. Main Street) Address Two: * (e.g. Reno, NV 89506) Address Three: Phone: * (e.g. 775-996-1343) E-Mail: *   Activation/Initialization Activation Date: * (YYYY-MM-DD) Initial Product Markup:* (percentage increase from the suppliers cost)

Payment Information:

Card Type:* Visa Mastercard American Express Discover Card Number:* (xxxx-xxxx-xxxx-xxxx) Expiration Date:* January February March April May June July August September October November December / 2025 2026 2027 2028 2029 2030 2031 2032 2033 2034 2035 2036 2037 2038 2039 2040 2041 2042 2043 Name on Card:* (e.g. John Doe) Billing Address:* (e.g. 1234 N. Main Street)   (e.g. Reno, NV 89506)