ORDER FORM

To order IMDS-a2 Basis and/or the IMDS-a2 REACh module or to renew an existing license, please fill in the order form below. After acceptance of the license conditions, you will immediately receive an order confirmation.

All data entered will be treated as confidential and will be saved only for order fulfillment.


New or Renewal
New Order
Renewal of existing license


How did you learn about the service IMDS-a2?
Service Pages/IMDS-Team (SI)
Recommendations by a Client/Supplier (CS)
Recommendations by an HP Training Partner (ET)


IMDS-a2	Order Date	14.05.2012
		Hewlett-Packard GmbH

	*Please select your scope of order
	Base Version
		2000,- € per user
	REACh Module
		950,- € per user


Invoice Information		Mr. Mrs.
	Opening/Title
	*First Name
	*Last Name
	*Telephone No.
	Fax No.
	*E-Mail Address
	*Company Name
	Department
	Contact Person (only if different to person above)
	*Contact Person E-Mail Address
	*Street
	*Zip or Postal Code
	*City
	Country
	State

*Tax Number


IMDS-a2 User Information	*Please insert the IMDS user IDs of the future IMDS-a2 users (if you insert more than one userID, please separate them by a blank)

IMDS-a2 User Company	*IMDS-Company-ID

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ORDER FORM