International Channels Order Form

Clients I+I Profile Info Request

InterInfo/Ideas + Information

Hilltop Business Center
South Hampton NH 03827-3509 USA
(603) 394-7600 (Phone)

(603) 505-4892 (Fax)
sales@interinfo.com

INTERNATIONAL IT ACQUISITIONS SERVICE (IIAS)

INTERNATIONAL IT VENTURE CAPITAL SERVICE (IIVCS)

INTERNATIONAL IT NEW VENTURES SERVICE (IINVS)

ORDER FORM

Please enter my organization as a subscriber at the special Charter rates indicated below.

I agree that the information provided will only be used within my organization.

Name:

Title:

Organization:

Address:

City/Postal Code:

Country:

Phone:

Fax:

eMail:

SELECT SERVICE:

See Box Below

-- INTERNATIONAL IT ACQUISITIONS SERVICE (IIAS)** = $750

-- INTERNATIONAL IT VENTURE CAPITAL SERVICE (IIVCS)** = $750

-- INTERNATIONAL IT NEW VENTURES SERVICE (IINVS)** = 750

**Includes Acquisitions, Venture Capital or New Ventures DATABASES on CD with semi-annual update; Internet Access to databases; eMail/Phone/Fax INQUIRY 1 Year.

SPECIFY SERVICE(S): -- Enter IIAS; IIVCS; and/or IINVS

(Charter rates until 29 February 2012 -- Regular rates: $1000

SELECT IIA/IIVC/IINV DATABASE FORMAT : (On CD ROM)
ACCESS
ACT
ASCII
Excel
FileMakerPro
Other

_______________________________________________________________

SELECT PAYMENT METHOD:

- Check
- Wire Transfer
- PayPal
- Bill Us -- PO#
- Amex/Mastercard/Visa/Discover (We will contact you for Name on card/Card #/Expiration Date)

Name:
Title:
Organization:
Address:
City/Postal Code:
Country:
Phone:
Fax:
eMail: