<p> CLE Tracker Order Form</p><p>Company Information</p><p>Company Name: </p><p>Address: </p><p>Address 2: </p><p>City: </p><p>State: </p><p>Zip: </p><p>Telephone Number: </p><p>Company Website address: </p><p>Number of Attorneys: </p><p>Company Contact Person</p><p>First Name: </p><p>Last Name: </p><p>Telephone Number: </p><p>E-mail address: </p><p>Company Room Number: </p><p>Payment method Credit Card Number*</p><p>Visa </p><p>MasterCard Security Code xxx</p><p>Name of Card Holder (name on card) Expiration date</p><p>Month Year: Check enclosed Payable to Urick Consulting LLC</p><p>Have us call for Credit Card Number Telephone number to call: </p><p>Order Information Qty Cost each Total</p><p>CLE Tracker for tracking : 1 employee $300.00 $0.00</p><p>CLE Tracker to track : 2-5 employees $600.00 $0.00</p><p>CLE Tracker to track : 6-15 employees $1,000.00 $0.00</p><p>CLE Tracker to track : 16-30 employees $1,500.00 $0.00</p><p>CLE Tracker to track : 31-50 employees $2,100.00 $0.00</p><p>CLE Tracker to track : 51 – 200 employees $2,500.00 $0.00</p><p>CLE Tracker to track 201 – 500 employees $3,000.00 $0.00</p><p>CLE Tracker to track 501-1000 employees $3,800.00 $0.00</p><p>CLE Tracker to track 1001-2500 employees $4,500.00 $0.00</p><p>ASP web pages w/1 license $2,000.00 $0.00</p><p>*ASP remote site licenses $600.00 $0.00</p><p>Total (Non Ohio Residents) $0.00</p><p>Ohio Residents</p><p>Ohio Residents add 8.00% Sales Tax $0.00</p><p>Total for Ohio Residents $0.00</p><p>*An ASP license is required for each remote site that will be accessing the databases.</p><p>Comments: </p><p>Submitting your order: E-mail: Save this completed order form and include it as an attachment in an e-mail message to [email protected].</p><p>Regular Postal Mail: Print this completed form and mail to Urick Consulting LLC, 5790 Preserve Lane Sheffield Village, Ohio 44054.</p><p>*It is not recommended to transmit credit card information via e-mail. Provide a telephone number and we will call to verify order and obtain credit card information or submit this order form using regular postal mail.</p>