Reseller (If Applicable)

CUSTOMER FORM
Maximum Availability Limited
PO Box 300 523, Albany, Auckland, New Zealand
Phone: +64 9 415 7008 Fax: +64 9 415 7018
Email:
Company Name:
Physical Address:
Postal Address:
(if different)
Country:
Contact Name:
Position:
Phone number: / Facsimile:
Contact Email:

Reseller (if applicable)

Company Name:
Contact Name:
Contact Email:

Customer Form no$ Maximum Availability Limited 1/3

Signature Details

By signing below you confirm your order of the software as per the attached Appendix and your acceptance of all terms and conditions as contained in the Maxava End User Licence Agreement and in the Maxava Maintenance Agreement.

Signed for and on behalf of the

Customer Form no$ Maximum Availability Limited 1/3

Customer:
Signature:
Name:
Title: / Date:

Appendix 1

**PLEASE TYPE OR PRINT CLEARLY IN BLOCK CAPITALS***

Software / System Details:

Computer 1 / Computer 2
Model Number:
(e.g. 820-0150(not 9406)) / ___-____ / ___-____
Active Processors: / -way / -way
Processor Group:
(e.g. P20) / P__ / P__
CPU Serial Number: / __-_____ / __-_____
OS Version: / V_R_ / V_R_

Software License Purchase Order: Currency:

Maxava Product: / Maxava HA -----
Commencement Date:
# of Apply Groups: / 1 / Unlimited / 1/ Unlimited
Used for:
(delete as appropriate) / SOURCE / TARGET / BOTH / SOURCE / TARGET / BOTH

Maintenance Agreement: *

Commencement Date:
Renewal Date:

Customer Form no$ Maximum Availability Limited 3/3

Other Purchases Related to this Project:

New IBM Hardware: / YES / NO
Details / Value (Optional)

Support:

In the first instance all requests for support should be directed to:
Organization: / Maximum Availability Ltd
Address: / PO Box 300-523, Albany
Auckland, New Zealand
Phone number: / +64-9-414-5172 / Facsimile: / +64-9-415-7008
Contact Name: / Peter Kania
Email: /

Office Use only: Order accepted by Maximum Availability Limited:

Order No:
Temp lickey:
Perm lickey:
Name: / Date:

Customer Form no$ Maximum Availability Limited 3/3