WL order form p1

							                                                 Manupatra Online Order Form
New order                    Existing Account                                              Corporate Office :
                                                                                           B-37 Sector 1 , NOIDA
                         Y            N                                                    U.P 201301
                                                                                           India
Renewal
                                                                               Billing Details (if different)
Company Name:                                                                  Contact Name / Co-ordinator:
Address:
                                                                               Address:



Phone:                                    Fax:                                            E-mail:
Contact details for payment purposes ( if different from user)
Name:                                                                                     Title:
Phone:                                    Fax:                                            E-mail:
Market Segment details                                                     No of computers & connection details
       Corporate                          Law Firm 1-20 Partners                     1-5 Computers
       Academic Institution               Law Firm 21-59 Partners                    6-15 Computers
       Government                         Law Firm 60-99 Partners                    More than 15 computers
       CS/CA                              Law Firm 100-149 Partners                  Dial UP / Lease Line / Cable / DSL   {Tick as Applicable]
                                          Law Firm 150 + Partners
Subscription Details
Module
No of Users
Amount
Service Tax
Total
IP Fixing details (if applicable)




References :

Name

Address

Tel

E Mail


Contract Details
Subscription Period
Remarks :




                                                                                                   Date
Sales Rep/Account Manager Name

For HO Use Only




Invoice No
Invoice Date                                     Signature of office contact
             Westlaw International Order Form - Supplementary Information



                   Please provide the following information to assist with efficient and accurate order processing & account
                                 set up, this is to be completed by the rep. Note this is for internal use only.
             YES        NO
                                   1. Does the customer require different "groups" to be set up? If YES, have
             Details:              these groups been identified on the Order Form?


             YES        NO
                                   2. Are products limited to any of the "groups" above?
             Details:


             YES        NO
                                   3. Is access to be blocked for any of the groups/products? If YES, has
             Details:              this been noted on the Order Form?


             YES        NO
                                   4. Is more than one Corporate Administrator required (for purposes of
             Details:              Chargeback)?


             YES        NO
                                   5. Does the customer require the trial passwords to be inactivated and
             Details:              new passwords to be assigned?


             YES        NO
                                   6. Is IP authentication required? .
                                   If YES, please complete details on Order Form.

             YES        NO
                                   7. Is this a "Bundled" Order? Is yes, please provide Pricing Break-down by
                                   Product (Total Amount per Product).

             Please attach this Supplementary Information Form to the Westlaw International Order Form




TLR Confidential                                                   2/9/2010                                                    Page 2