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EVT Quote Order Form - bLoyal

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EVT Quote Order Form - bLoyal Powered By Docstoc
					Easy Quote Instructions.
1 Complete the yellow fields on the Order Worksheet. This auto-completes your quote/order form.

2 Print Customer Order Form
    > Why Required?: bLoyal.com needs a customer signature agreeing to subscription and payment terms.


3 Have your customer complete and sign the Order Form

4 Send or fax the Order Form to EVT Solutions | (425) 484-8300
                                                                                                                                        EVT Loyalty Essentials / Order Worksheet
                                                                 EVT:    n/a                   Date: July 7, 2008                                                                                                                  For Internal Use Only
                                                                 Type:   Partner            Partner: n/a
                                                                 Tax?:   Yes            Partner Rep: n/a
                                                             Tax Rate:   9.00%                Client:
                                                                                         Monthly
1. EVT Payment Processing                                                   Setup
                                                                                       Subscription
                                                                                                                                                            Notes                                                      Required?             Quick Notes

     Single Store Retailers
     EVT Loyalty Essentials Service Membership                               $195.00          $29.00      Includes Customer Profile Management, E-Mail Marketing and On-Line Payment Reporting                            No

     Multi-Store Retailers
     EVT Loyalty Essentials Service Membership (per store)                                    $19.00      Includes Customer Profile Management, E-Mail Marketing and On-Line Payment Reporting                            No
 0   General Setup (includes the first store)                                $195.00                      Includes all activites to setup the first locations and train user on EVT Loyalty Essentials                    No
 0   Additional Stores                                                        $45.00                      Includes setting up all additional locations for payment processing                                             No

                                                                                        Monthly
                                                                                                                                                            Notes
                                                                                       Usage Fees
     Price per delivered email
 √      First 2,500                                                                         Included      First 2,500 emails sent during the month are included
 √      2,501+                                                                                 $0.01      Per email delivered over and above 2,500 during a given month


3. Payment Processing HW & SW                                            Unit Costs                                                                         Notes
     Terminals for non-PC POS Merchants
     Hypercom - T4100-IP (PCI)                                               $495.00                   IP or dial terminal with internal pin pad. Includes injection and shipping                                         No
     Hypercom - Pinpad 1310-V (PCI)                                          $175.00                   Optional external pin pad for the T4100-IP. Includes injection and shipping                                        No
     First Data - FD50                                                       $245.00                   Dial terminal without internal pin pad. Injection is purchased with the pin pad. Includes shipping                 No
     First Data - Pinpad FD10                                                $150.00                   Pin pad for the FD 50. Includes injection and shipping                                                             No
     Verifone - Pinpad 1000 (Refurbished)                                     $75.00                   Available for swap for Merchants with existing units only. Includes injection and shipping                         No

     For Microsoft Dynamics RMS based Merchants
     Hypercom - L4150 (Color) with serial cable                              $495.00                   Includes Signatrue capture and internal pin pad. Includes injection and shipping. Requires TPI SW                  No
     Hypercom - L4250 (BW) with serial cable                                 $395.00                   Includes Signatrue capture and internal pin pad. Includes injection and shipping. Requires TPI SW                  No
     Hypercom - USB cable                                                     $19.00                   Optional USB cable for the L4150 and L4250 terminals                                                               No
     Microsoft Dynamics RMS Plug-in                                          $279.00                   Includes SmartPayments client and RMS connector                                                                    No
     SmartPayments Client SDK                                                $495.00                   Includes SmartPayments Client Software Development Kit                                                             No

                                                                                        Monthly
4. Integrated Service Providers                                             Setup
                                                                                      Subscription
                                                                                                                                                            Notes

     Web Site Hosting and SSL Certificates                                 Buy Online    Buy Online       Go to www.evtretail-webhosting.com                                                                              No
     USAePay Gateway with EVT Payment Processing                              Waived        Waived        Payment processing charged separately by provider                                                               No


                                                                             Special Instructions and Comments




                                                                                           Order Summary

                                                                                               One Time Fees
                                                                           Setup:              $0.00
                                                             Hardware & Software:              $0.00
                                                                     Taxable Y/N:               Yes
                                                                        Tax Rate:             9.00%
                                                                          Taxes:               $0.00
                                                                  Order Subtotal:              $0.00
                                                                       Discounts:
                                                                     Order Total:              $0.00

                                                                                    Estimated Monthly Subscription Fees
                                                              Subscription Subtotal:          $0.00
                                                              Subscriptions Total:            $0.00    Other usage charges may apply
                                                                                                                                                                                           Revision Date: 10/13/2008
                                                                                                                                                                                              EVT Loyalty Essentials / Order Form

                                                                                                                                                                                                                                                                   0
                                                                                                Monthly            Setup          Subscription
1. EVT Payment Processing                                                     Setup
                                                                                              Subscription         Total             Total
                                                                                                                                                                                                         Notes


         Single Store Retailers
         EVT Loyalty Essentials Service Membership                                 $195.00            $29.00              $0.00             $0.00       Includes Customer Profile Management, E-Mail Marketing and On-Line Payment Reporting

         Multi-Store Retailers
         EVT Loyalty Essentials Service Membership (per store)                       $0.00            $19.00                                $0.00       Includes Customer Profile Management, E-Mail Marketing and On-Line Payment Reporting
         General Setup (includes the first store)                                  $195.00             $0.00              $0.00                         Includes all activites to setup the first locations and train user on EVT Loyalty Essentials
         Additional Stores                                                          $45.00             $0.00              $0.00                         Includes setting up all additional locations for payment processing

                                                                                              Monthly Usage
0                                                                                                 Fees
                                                                                                                                   Usage Total                                                           Notes

         Price per delivered email
    √    First 2,500                                                                                Included                             Included       First 2,500 emails sent during the month are included
    √    2,501+                                                                                        $0.01                              Per Mail      Per email delivered over and above 2,500 during a given month


3. Payment Processing HW & SW                                              Unit Costs                          HW & SW Total                                                                             Notes

         Terminals for non-PC POS Merchants
         Hypercom - T4100-IP (PCI)                                                 $495.00                                $0.00                         IP or dial terminal with internal pin pad. Includes injection and shipping
         Hypercom - Pinpad 1310-V (PCI)                                            $175.00                                $0.00                         Optional external pin pad for the T4100-IP. Includes injection and shipping
         First Data - FD50                                                         $245.00                                $0.00                         Dial terminal without internal pin pad. Injection is purchased with the pin pad. Includes shipping
         First Data - Pinpad FD10                                                  $150.00                                $0.00                         Pin pad for the FD 50. Includes injection and shipping
         Verifone - Pinpad 1000 (Refurbished)                                       $75.00                                $0.00                         Available for swap for Merchants with existing units only. Includes injection and shipping

         For Microsoft Dynamics RMS based Merchants
         Hypercom - L4150 (Color) with serial cable                                $495.00                                $0.00                         Includes Signatrue capture and internal pin pad. Includes injection and shipping. Requires TPI SW
         Hypercom - L4250 (BW) with serial cable                                   $395.00                                $0.00                         Includes Signatrue capture and internal pin pad. Includes injection and shipping. Requires TPI SW
         Hypercom - USB cable                                                       $19.00                                $0.00                         Optional USB cable for the L4150 and L4250 terminals
         Microsoft Dynamics RMS Plug-in                                            $279.00                                $0.00                         Includes SmartPayments client and RMS connector
         SmartPayments Client SDK                                                  $495.00                                $0.00                         Includes SmartPayments Client Software Development Kit

                                                                                                Monthly                           Subscription
4. Integrated Service Providers                                               Setup
                                                                                              Subscription
                                                                                                                Setup Total
                                                                                                                                     Total
                                                                                                                                                                                                         Notes

0        Web Site Hosting and SSL Certificates                                   Buy Online      Buy Online              $0.00            $0.00         Go to www.evtretail-webhosting.com
         USAePay Gateway with EVT Payment Processing                                Waived          Waived              Waived          Waived          Processing charged separately by provider




                                                                                                     Special Instructions and Comments




                                                                                                Order Summary / Review and Sign Page 2

         EVTretail.com Representative:                                                Total Setup, Software, Discovery, Training & Support
             n/a                                                                                                    Setup:            $0.00
         Partner:                                                                                      Hardware & Software:           $0.00
             n/a                                                                                                    Taxes:            $0.00
         Partner Representative:                                                                           Order Subtotal:           $0.00
             n/a
                                                                                                             Net Due w/Order:      $             -
                                 Quote/Order Form Generation Date:
                                                         July 7, 2008
                                         Quotes are valid for 30 days                             Estimated Monthly Subscription Fees
                                                                     0                           Monthly Subscription Total:       $             -      Other usage charges may apply



                                                                                                        EVT Solutions Order Agreement

Total Setup charges are due with order. If your are not completely satisfied with your deployment process within the first 60 days after your Order Date we will refund 100% of the Setup charges.



Initial subscription period shall be 12 months. During the initial 30 days after your Order Date your Subscription is free of charge. Subscription billing will begin immediatley after the 30th day. Subsequent terms shall be 12 months per the EVT
Solutions Subscription Agreement. The subscription amount is charged on or about the 1st day of each month and is prorated for the 1st month. Usage fees, if applicable, will be charged as of the Order Date. All EVT subscriptions and usage amounts
are charged by ACH Debit or automatic credit card payment per Billing Authorization on or about the 1st day of the month following usage. If this order appends an existing EVT Solutions subscriber account, any subscriptions included on this order will be
assigned the same renewal date as the primary account.


This confirms that the Subscriber identified below is purchasing the EVT Products and Services described on this order form. Prices shown may not include any or all of taxes that may apply. Any such taxes are the sole responsibility of the Subscriber.
Use of the EVT Products and Services by Subscriber shall be governed by the Terms and Conditions of the EVT Subscriber Agreement. By signing below you agree that you have read and agree to the terms and conditions of the EVT
Subscriber Agreement: http://www.evtsolutions.com/subscriptionagreement.

Company:                                                                                                       Date:

Name                                                                                                           Phone:

Title:                                                                                                                                                     Complete and sign this page and fax entire order form (2 pages) and Account Setup Form
Email:                                                                                                                                                                                 to Adrianne at 1(425) 484-8300

Signature:



                                                                                                                       Payment Section

Net Due with Order | Select Method:                                      $0.00                                 Monthly Subscription | Select Method:                                                      $0.00
         Debit my checking account.                                                                                               Debit my checking account.
         Charge my credit card.                                                                                                   Charge my credit card.
         I am sending a check.


ACH Debit Authorization Section (Complete if you have selected any Debit Method - Attach Voided Check)
(I/We) do hereby authorize EVT Solutions, hereinafter named the COMPANY, to initiate recurring (debit or credit) entries to to (my/our) (Checking Account / Savings Account) as indicated and named below as the depository financial institution, hereinafter
named FINANCIAL INSTITUTION. (I/We) acknowledge that the origination of ACH transactions to (my/our) account must comply with the provisions of U.S. law. Furthermore, if any such debt(s) should be returned NSF, (I/we) authorize the COMPANY
to collect such debit(s) by electronic debit and subsequently collect a returned debit NSF fee of $25.00 per item by electronic debit from (my/our) account identified below. I am a duly authorized check signer on the financial institution identified below, and
authorize all of the above as evidenced by my signature below.



This authorization is to remain in full force and effect until the COMPANY has received written notification from me (or either of us) of its termination in such time and in such manner as to afford the COMPANY and FINANCIAL INSTITUTION a reasonable
opportunity to act upon it. Payment Amount(s): As described in the attached bLoyal.com Subscriber Order form and per the Payment Methods section above.
Bank Name                                                                                                              Address:
Bank Branch                                                                                                     City/State/Zip:
Routing Number
Account Number
Signature:                                                                                                                Date:

Credit Card Section (Complete if you have selected a Credit Card payment method)

(I/We) authorize bLoyal.com to charge this credit card for subscriptions described in the attached EVTRetail Subscriber Order form and per the Payment Methods section selections above.
Card Type (Circle):           VISA             MC           AMEX                                               Billing Address
Card Number:                                                                                                    City/State/Zip:
Expiration Date:                                                                                                Billing Phone:
Name on Card:
Signature:                                                                                                                Date:
No
Yes

				
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