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1. Purchaser Information |
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Name: |
______________________________ |
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Title : |
______________________________
Today's date:
_______________________ |
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Company: |
______________________________ |
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Address: |
______________________________
(Street Address) __________ (Suite) |
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______________________________
(City) |
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______________________________
(State / Province) |
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______________________________
(Zip / Postal Code) |
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______________________________
(Country) |
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| 2. Order
Information |
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Item |
Units |
Description |
Unit Price |
Total |
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1 |
_______ |
Fee for resolution service per Retainer
(per party) |
$2,500 US |
_______ |
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2 |
_______ |
Change to alternate resolution process
in Step 6 (per party) |
$100 US |
_______ |
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3 |
_______ |
Additional 2-hour resolution session
blocks, if needed, for special reasons (per party) |
$400 US |
_______ |
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4 |
_______ |
Record of
Resolution Session
(CD Rom) |
$100 US |
_______ |
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5 |
_______ |
Translation services per
Electronic Courthouse quote |
per quote |
_______ |
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6 |
_______ |
Other services to address special needs
per Electronic Courthouse quote |
per quote |
_______ |
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Add 7% G.S.T
*For Canadian residents only |
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_______ |
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Total: |
_______
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| 3. Payment
Information |
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VISA |
Cardholder Name ________________________ |
____________________ |
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Card Number |
____________________ |
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Expiry Date |
____________________ |
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Cardholder
Signature |
____________________ |
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