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USA Trade Online Site License Order Form
USA Trade Online Site License Order Form
(Rates effective October 1, 2007 and are in U.S. dollars and subject to change)
Please select products below and mail or fax this form to:
STAT-USA Fax: (202) 482-2164
HCHB Room 4879 Voice numbers:
U.S. Department of Commerce (202) 482-1986
Washington, DC 20230 1-800-STAT-USA
Federal ID Number: 52-1259974 1-800-782-8872
STAT-USA/Internet (http://www.stat-usa.gov):
Institution Type (please select one and fill in the corresponding pricing requirements):
Educational (4-year program) ____ FTE Undergraduate: ____ x $.45 = _________
FTE Graduate: ____ x $.60 = _________
Community College (2-year program) ____ FTE Students: ____ x $.30 = _________
Library ____ Number of Workstations: ____ x $15.00 = _________
Standard (non-educational) ____ Number of Users: ____ $1000 per 10 users = _________
TOTAL COST: __________________
Maximums, Minimums, and Rounding: The minimum charge is $750 and prices are rounded up to the nearest $50. The maximum charge is $8,000 for an Educational (4YR) College, $7,000 for a Community College or Library, and $100,000 for a Standard license.
METHOD OF PAYMENT:
(__) Credit card: (__) American Express (__) VISA
(__) MasterCard (__) Discover
Credit card number _________________________________ Exp Date ___________
Name ____________________________________________________________________
Signature _______________________________________________________________
(__) Check or money order payable to "STAT-USA" -- DO NOT FAX THESE!
MAILING ADDRESS:
Contact name ___________________________________________________
E-mail address (required) ______________________________________________
Company name ___________________________________________________
Street address ___________________________________________________
___________________________________________________
City, State, ZIP ___________________________________________________
Country (if not USA) ___________________________________________________
Day-time phone (_____) _____________________________________________
Fax number (_____) _____________________________________________
Numeric IP addresses (required for Shared Access Account):
______________________________________________________________________
______________________________________________________________________