License Order Form


Please fill in all of the information below, and print form.
Do not leave any fields blank.

Institution or School Name:
Department:
Office Address:
Office Address 2:
City, State:				Zip Code:
End User Contact Name:
Phone:			Fax:
E-Mail:
Purchase Order or University Procurement Card#:				Exp Date:


If you are paying with a University Procurement Card, please fill in below. If you are paying with a PO, stop here, attach this form to the PO and forward to UBMicro.

Description and Platform		Part Number	Quantity	Cost	Extended Cost
Windows XP Pro Upgrade		E85-00433		$62.99






				Order Total >


Submit to UBMicro with a valid form of payment.
Orders will not be processed without a payment being received.
Thank you.

UBMicro Sales Center The Commons Suite 109 520 Lee Entrance Road Amherst NY 14228
Phone: 716-645-5819 Fax: 716-645-3884 E-Mail: ubmicro@buffalo.edu